=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003798992
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARINA RENDON ORTIZ LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2025
-----------------------------------------------------
Last Update Date | 07/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15851 DALLAS PKWY STE 600
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-6030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-267-9556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 HUMMINGBIRD DR
-----------------------------------------------------
City | CELINA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75009-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-704-9070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 69520
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------