Healthcare Provider Details

I. General information

NPI: 1558273201
Provider Name (Legal Business Name): ALFREDO E ORTIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10208 S INDIANAPOLIS AVE # 301
CHICAGO IL
60617-6033
US

IV. Provider business mailing address

19707 CASA BROOK LN
HOCKLEY TX
77447-2371
US

V. Phone/Fax

Practice location:
  • Phone: 866-413-1988
  • Fax:
Mailing address:
  • Phone: 866-413-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: