Provider Demographics
NPI:1043759954
Name:ORTEGA, LAUREN ELISE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELISE
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9617 GREAT HILLS TRL
Mailing Address - Street 2:APT 1023
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6272
Mailing Address - Country:US
Mailing Address - Phone:210-840-8401
Mailing Address - Fax:
Practice Address - Street 1:3595 RANCH ROAD 620 S
Practice Address - Street 2:UNIT 220
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6803
Practice Address - Country:US
Practice Address - Phone:210-840-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB279941103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst