Healthcare Provider Details

I. General information

NPI: 1033354535
Provider Name (Legal Business Name): EMMA ORTEGA LPPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 3372
LOS LUNAS NM
87031-3372
US

IV. Provider business mailing address

224 BONITO LN NW
LOS LUNAS NM
87031-8434
US

V. Phone/Fax

Practice location:
  • Phone: 505-565-1619
  • Fax: 505-565-1620
Mailing address:
  • Phone: 505-917-7674
  • Fax: 505-359-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0159661
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: