Healthcare Provider Details

I. General information

NPI: 1467935593
Provider Name (Legal Business Name): CASEY ANN APPLEGATE-AGUILAR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY ANN APPLEGATE

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 HIGHWAY 50
PECOS NM
87552
US

IV. Provider business mailing address

PO BOX 710
PECOS NM
87552-0710
US

V. Phone/Fax

Practice location:
  • Phone: 505-757-6482
  • Fax:
Mailing address:
  • Phone: 505-426-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0202941
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0201571
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: