Healthcare Provider Details

I. General information

NPI: 1003004755
Provider Name (Legal Business Name): LORI M ORTIZ M.A. LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 07/11/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NM BLDG73, MSC-06-3870
ALBUQUERQUE NM
87131
US

IV. Provider business mailing address

1 UNIVERSITY OF NM MSC09-3870
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax: 505-277-2020
Mailing address:
  • Phone: 55-277-3136
  • Fax: 505-277-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberT-0107161
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0107161
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: