Provider Demographics
NPI:1780772418
Name:SMALLEY, LORA LORAY (LMFT)
Entity type:Individual
Prefix:MS
First Name:LORA
Middle Name:LORAY
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:JEAN
Other - Last Name:NITCZNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10813 BUCKBOARD ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5464
Mailing Address - Country:US
Mailing Address - Phone:505-818-9762
Mailing Address - Fax:
Practice Address - Street 1:10131 COORS BLVD NW STE H8
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4048
Practice Address - Country:US
Practice Address - Phone:505-900-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMF0127961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist