Healthcare Provider Details

I. General information

NPI: 1780772418
Provider Name (Legal Business Name): LORA LORAY SMALLEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORA JEAN NITCZNSKI

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10131 COORS BLVD NW STE H8
ALBUQUERQUE NM
87114-4048
US

IV. Provider business mailing address

10813 BUCKBOARD ST NW
ALBUQUERQUE NM
87114-5464
US

V. Phone/Fax

Practice location:
  • Phone: 505-900-5084
  • Fax:
Mailing address:
  • Phone: 505-818-9762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCMF0127961
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: