Healthcare Provider Details

I. General information

NPI: 1194639476
Provider Name (Legal Business Name): MICHELE EUGENIA CASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N MAIN ST STE 1
LAS CRUCES NM
88001-1281
US

IV. Provider business mailing address

1615 REDWOOD RD APT 36C
SAN MARCOS TX
78666-1416
US

V. Phone/Fax

Practice location:
  • Phone: 505-390-2080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0850
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: