Healthcare Provider Details

I. General information

NPI: 1992426407
Provider Name (Legal Business Name): MEGAN WILEY-CARRIZO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN WILEY PSY.D.

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/28/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

IV. Provider business mailing address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-1881
  • Fax: 575-288-1889
Mailing address:
  • Phone: 480-296-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-005498
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: