Healthcare Provider Details

I. General information

NPI: 1669682258
Provider Name (Legal Business Name): SHAWNE STACIE ORTIZ PSYD, LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2556 HUNT ST
NEW BRAUNFELS TX
78130-2998
US

IV. Provider business mailing address

2556 HUNT ST
NEW BRAUNFELS TX
78130-2998
US

V. Phone/Fax

Practice location:
  • Phone: 210-685-1529
  • Fax: 866-556-8569
Mailing address:
  • Phone: 210-685-1529
  • Fax: 866-556-8569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61423
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number61423
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number34976
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number36936
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: