Healthcare Provider Details

I. General information

NPI: 1952813131
Provider Name (Legal Business Name): JUAN CASAUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2017
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 MOUNTAIN RD NW
ALBUQUERQUE NM
87102-1855
US

IV. Provider business mailing address

1102 MOUNTAIN RD NW
ALBUQUERQUE NM
87102-1855
US

V. Phone/Fax

Practice location:
  • Phone: 505-315-0656
  • Fax:
Mailing address:
  • Phone: 505-315-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0164921
License Number StateNM

VIII. Authorized Official

Name: JUAN CASAUS
Title or Position: PRACTITIONER
Credential: LPCC
Phone: 505-710-5516