Provider Demographics
NPI:1417275280
Name:ORTIZ, ANTOINETTE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10604 SEDALIA DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2942
Mailing Address - Country:US
Mailing Address - Phone:214-956-3509
Mailing Address - Fax:972-526-5524
Practice Address - Street 1:4031 W PLANO PKWY STE 211
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5627
Practice Address - Country:US
Practice Address - Phone:214-956-3509
Practice Address - Fax:972-526-5524
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health