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General NPI Number Information
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NPI Number | 1154243251
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Entity Type | Individual
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Provider Name | CLARISSA KASELONIS
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Gender | Female
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 3655 CARLISLE BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-1644
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Country | US
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Telephone | 866-425-1912
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Fax |
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Provider Business Mailing Address
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Address Line | 2148 RYAN PL NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-3074
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CTB-2025-0826
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License Number State | NM
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