Individual
ALISA MARIE MOORTGAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
INTERN
Contact information
Practice address
6801 JEFFERSON ST NE STE 301, ALBUQUERQUE, NM 87109-7390
(505) 705-1701
(505) 212-1253
Mailing address
5601 ADDIS AVE SE, ALBUQUERQUE, NM 87106-9616
(571) 271-5650
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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