=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740739705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE MICHELE ORTIZ-CROUCH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2016
-----------------------------------------------------
Last Update Date | 12/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7201 SCHIRRA CT STE E
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93313-2051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-834-7564
-----------------------------------------------------
Fax | 661-831-8882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7850 WHITE LN # E249
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-7698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-834-7564
-----------------------------------------------------
Fax | 661-831-8882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 95567
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------