Provider Demographics
NPI:1013598614
Name:ORTIZ, CHRISTIAN RENEE (LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:RENEE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W IRVINGTON RD BLDG 10
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-3050
Mailing Address - Country:US
Mailing Address - Phone:520-309-4596
Mailing Address - Fax:
Practice Address - Street 1:101 W IRVINGTON RD BLDG 10
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-3050
Practice Address - Country:US
Practice Address - Phone:520-309-4596
Practice Address - Fax:520-309-2560
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000740103K00000X
AZLAC-17230101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst