Healthcare Provider Details

I. General information

NPI: 1760318927
Provider Name (Legal Business Name): JESSE ORTEGA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JESSE ORTEGA III

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4975 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-5043
US

IV. Provider business mailing address

7783 AUTUMN LEAF WAY
COLORADO SPRINGS CO
80922-3586
US

V. Phone/Fax

Practice location:
  • Phone: 719-506-2070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0023986
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: