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General NPI Number Information
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NPI Number | 1043759954
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Entity Type | Individual
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Provider Name | LAUREN ELISE ORTEGA
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Gender | Female
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 3595 RANCH ROAD 620 S UNIT 220
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City | AUSTIN
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State | TX
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Zip | 78738-6803
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Country | US
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Telephone | 210-840-8401
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Fax |
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Provider Business Mailing Address
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Address Line | 9617 GREAT HILLS TRL APT 1023
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City | AUSTIN
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State | TX
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Zip | 78759-6272
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Country | US
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Telephone | 210-840-8401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB279941
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License Number State | TX
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