Provider Demographics
NPI:1417011206
Name:BORTZ, GERALD JOHN (LPC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:JOHN
Last Name:BORTZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 QUINCE TREE PL
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3550
Mailing Address - Country:US
Mailing Address - Phone:281-205-9127
Mailing Address - Fax:
Practice Address - Street 1:1001 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 190
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3241
Practice Address - Country:US
Practice Address - Phone:281-367-0733
Practice Address - Fax:281-298-1915
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health