Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | T-0107161 | NM |
Y | 101YM0800X | Mental Health Counselor | T-0107161 | NM |
NPI | 1003004755 |
---|---|
Provider Name | Ms. Lori M Ortiz |
First Address | Albuquerque, NM 87196-4112 |
Second Address | Albuquerque, NM 87110-4058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 09/10/2007 |