Healthcare Provider Details

I. General information

NPI: 1689638132
Provider Name (Legal Business Name): LORENZO ORTIZ LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N AVENUE C
CRYSTAL CITY TX
78839-3550
US

IV. Provider business mailing address

203 N AVENUE C
CRYSTAL CITY TX
78839-3550
US

V. Phone/Fax

Practice location:
  • Phone: 830-374-9191
  • Fax:
Mailing address:
  • Phone: 830-374-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14744
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: