Provider Demographics
NPI:1700904638
Name:ORTEGA, ANGELA M (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 HWY 478
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-4430
Mailing Address - Country:US
Mailing Address - Phone:575-882-5101
Mailing Address - Fax:575-882-2858
Practice Address - Street 1:820 HWY 478
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-4430
Practice Address - Country:US
Practice Address - Phone:575-882-5101
Practice Address - Fax:575-882-2858
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0092911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM600035OtherNM MEDICAID