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General NPI Number Information
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NPI Number | 1598572224
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Entity Type | Individual
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Provider Name | GRACIELA ORTIZ LPC
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 29803 N LEGENDS VILLAGE CIR
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City | SPRING
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State | TX
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Zip | 77386-2051
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Country | US
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Telephone | 832-696-2061
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Fax |
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Provider Business Mailing Address
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Address Line | 20 HOSPITAL DR STE 4
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City | TOMS RIVER
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State | NJ
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Zip | 08755-6434
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Country | US
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Telephone | 732-831-6094
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 84067
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License Number State | TX
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