Provider Demographics
NPI:1093035412
Name:ORTEL, LYNN NELSON WHITEHEAD (LPC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:NELSON WHITEHEAD
Last Name:ORTEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3710
Mailing Address - Country:US
Mailing Address - Phone:207-797-3760
Mailing Address - Fax:207-797-2851
Practice Address - Street 1:91 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3710
Practice Address - Country:US
Practice Address - Phone:207-797-3760
Practice Address - Fax:207-797-2851
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4275101YP2500X
MECC2952101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional