Provider Demographics
NPI:1588961833
Name:CASAUS, JUAN IGNACIO (LPCC)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:IGNACIO
Last Name:CASAUS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 MOUNTAIN RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1855
Mailing Address - Country:US
Mailing Address - Phone:505-315-0656
Mailing Address - Fax:
Practice Address - Street 1:1102 MOUNTAIN RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1855
Practice Address - Country:US
Practice Address - Phone:505-315-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0137761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health