MEDICARE: GRACIELA ORTIZ LPC

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	84067	TX

General Provider Information

NPI Number	:	1598572224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACIELA ORTIZ LPC

Provider Business Mailing Address
First Line	:	20 HOSPITAL DR STE 4
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-6434
Country	:	US
Telephone Number	:	732-831-6094
Fax Number	:

Provider Business Practice Location Address
First Line	:	29803 N LEGENDS VILLAGE CIR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-2051
Country	:	US
Telephone Number	:	832-696-2061
Fax Number	:

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

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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