Provider Demographics
NPI:1033531371
Name:ORTEGA, SANDRA ANN (LAMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3758
Mailing Address - Country:US
Mailing Address - Phone:575-522-4004
Mailing Address - Fax:
Practice Address - Street 1:2117 WINDSOR PL
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1500
Practice Address - Country:US
Practice Address - Phone:575-639-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NMCTB-2023-0662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74481Medicaid