Healthcare Provider Details

I. General information

NPI: 1114628690
Provider Name (Legal Business Name): JORGE OROZCO MENTAL HEALTH COACH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 HEMPHILL ST
FORT WORTH TX
76110-5200
US

IV. Provider business mailing address

400 N ERVAY ST UNIT 131504
DALLAS TX
75313-0157
US

V. Phone/Fax

Practice location:
  • Phone: 817-715-3180
  • Fax:
Mailing address:
  • Phone: 945-247-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number1349187
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC-MHC-301
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: