MEDICARE: JORGE HUMBERTO ORTIZ LPC-ASSOCIATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	89312	TX

General Provider Information

NPI Number	:	1689437618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE HUMBERTO ORTIZ LPC-ASSOCIATE

Provider Business Mailing Address
First Line	:	15835 FOOTHILL FARMS LOOP APT 333
Second Line	:
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-3233
Country	:	US
Telephone Number	:	409-344-1931
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N CAPITAL OF TEXAS HWY STE 117
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-3302
Country	:	US
Telephone Number	:	512-552-2765
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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