Provider Demographics
NPI:1396830972
Name:B. ORTIZ COUNSELING SERVICES CENTER
Entity Type:Organization
Organization Name:B. ORTIZ COUNSELING SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MH PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRUNILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:713-851-8145
Mailing Address - Street 1:23003 GOOD DALE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-7009
Mailing Address - Country:US
Mailing Address - Phone:713-851-8145
Mailing Address - Fax:281-821-2282
Practice Address - Street 1:150 W PARKER RD STE 505
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-2938
Practice Address - Country:US
Practice Address - Phone:713-851-8145
Practice Address - Fax:281-821-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372591041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1802084Medicaid
TX1802035Medicaid