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NPI Code Detail

MEDICARE: LORRISSA SHORT LADAC

MEDICARE: LORRISSA SHORT LADAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCTB-2026-0229NM
2101YA0400XAddiction (Substance Use Disorder) CounselorCTB-2023-0629NM
3175T00000XPeer Specialist1311NM

General Provider Information

NPI Number : 1013698612
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORRISSA SHORT LADAC
Provider Business Mailing Address
First Line : 1900 WESTRIDGE RD
Second Line :
City : CARLSBAD
State : NM
Zip : 88220-3550
Country : US
Telephone Number : 505-484-0406
Fax Number :
Provider Business Practice Location Address
First Line : 1900 WESTRIDGE RD
Second Line :
City : CARLSBAD
State : NM
Zip : 88220-3550
Country : US
Telephone Number : 575-725-5552
Fax Number : 575-725-5552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2023
Last Update Date : 04/07/2026

Similar Medicare Providers

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Practice Location Address:
1900 WESTRIDGE RD
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88220-3550
Practice Phone: 575-725-5552
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1518800283 — KENDRA KEE RN
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1710968193 — KATHRYN G. LACKNER LPCC
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1114952033 — BRENT SCHRADER LCSW
Practice Location Address:
1900 WESTRIDGE RD
CARLSBAD, NM
88220-3550
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Practice Fax:
1407005796 — ELISABETH ANN MOORE LISW
Practice Location Address:
1900 WESTRIDGE RD
CARLSBAD, NM
88220-3550
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Practice Fax: 575-725-5552
1366693996 — PATRICIA GAIL ANAYA LCSW
Practice Location Address:
1900 WESTRIDGE RD
CARLSBAD, NM
88220-3550
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Practice Fax: 575-725-5552

Directions to “ LORRISSA SHORT LADAC” Practice Location

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