MEDICARE: IVONNE MARINA ORTEGA LPCC16302

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPCC16302	CA

General Provider Information

NPI Number	:	1003215609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVONNE MARINA ORTEGA LPCC16302

Provider Business Mailing Address
First Line	:	6111 SUN VALLEY DR TRLR 213
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-3540
Country	:	US
Telephone Number	:	619-600-9614
Fax Number	:

Provider Business Practice Location Address
First Line	:	6111 SUN VALLEY DR TRLR 213
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-3540
Country	:	US
Telephone Number	:	619-600-9614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	03/17/2025

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