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General NPI Number Information
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NPI Number | 1760812853
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Entity Type | Individual
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Provider Name | LORA BLAZINA LPC, MHSP
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Gender | Female
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 12760 SAN RAFAEL AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-1133
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Country | US
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Telephone | 505-382-9742
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1602
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City | TIJERAS
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State | NM
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Zip | 87059-1602
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Country | US
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Telephone | 505-382-9742
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3074
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License Number State | TN
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