Healthcare Provider Details

I. General information

NPI: 1790629947
Provider Name (Legal Business Name): LORI ELISABETH ALDRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 ST VALENTINE
LA MESA NM
88044
US

IV. Provider business mailing address

423 N CAMPUS HOUSING
LAS CRUCES NM
88003-1504
US

V. Phone/Fax

Practice location:
  • Phone: 575-650-3997
  • Fax:
Mailing address:
  • Phone: 719-205-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: