Provider Demographics
NPI:1013373547
Name:ERICKA ORTIZ LCPC NBCC PC
Entity Type:Organization
Organization Name:ERICKA ORTIZ LCPC NBCC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-612-3537
Mailing Address - Street 1:799 ROOSEVELT RD
Mailing Address - Street 2:BUILDING 4. SUITE 101
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5908
Mailing Address - Country:US
Mailing Address - Phone:773-612-3537
Mailing Address - Fax:
Practice Address - Street 1:799 ROOSEVELT RD
Practice Address - Street 2:BUILDING 4. SUITE 101
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5908
Practice Address - Country:US
Practice Address - Phone:773-612-3537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty