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General NPI Number Information
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NPI Number | 1013698612
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Entity Type | Individual
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Provider Name | LORRISSA SHORT LSAA
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Gender | Female
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 12 UNSER BLVD SE STE C
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City | RIO RANCHO
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State | NM
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Zip | 87124-6300
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Country | US
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Telephone | 505-636-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 4401 SAFELITE BLVD NE APT 6216
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City | RIO RANCHO
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State | NM
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Zip | 87144-9135
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Country | US
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Telephone | 505-484-0406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CTB-2023-0629
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 1311
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CTB-2023-0629
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License Number State | NM
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