Provider Demographics
NPI:1871646950
Name:MORA, GENETTE RACHEL (LMFT)
Entity type:Individual
Prefix:
First Name:GENETTE
Middle Name:RACHEL
Last Name:MORA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 MORRISSEY ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-5473
Mailing Address - Country:US
Mailing Address - Phone:505-585-1352
Mailing Address - Fax:
Practice Address - Street 1:3104 MORRISSEY ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5473
Practice Address - Country:US
Practice Address - Phone:505-585-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49836106H00000X
NMCMF0164941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM597-557-884Medicaid