Healthcare Provider Details

I. General information

NPI: 1114808367
Provider Name (Legal Business Name): BRIAN EUGENE SELZLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 EL PASEO RD
LAS CRUCES NM
88001-6012
US

IV. Provider business mailing address

385 CALLE DE ALEGRA BLDG A
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-459-1751
  • Fax: 855-538-1790
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-0973
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: