Provider Demographics
NPI:1114628690
Name:OROZCO, JORGE (MENTAL HEALTH COACH)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:OROZCO
Suffix:
Gender:M
Credentials:MENTAL HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N ERVAY ST UNIT 131504
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75313-0157
Mailing Address - Country:US
Mailing Address - Phone:945-247-7074
Mailing Address - Fax:
Practice Address - Street 1:2606 HEMPHILL ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-5200
Practice Address - Country:US
Practice Address - Phone:817-715-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1349187101YP1600X
VAC-MHC-301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
C-MHC-301OtherAMERICAN ASSOCIATION OF CHRISTIAN COUNSELORS
1349187OtherPREPARE/ENRICH
C-MHC-101OtherAMERICAN ASSOCIATION OF CHRISTIAN COUNSELORS
C-MHC-201OtherAMERICAN ASSOCIATION OF CHRISTIAN COUNSELORS