Provider Demographics
NPI:1437367711
Name:ORTIZ, ELIZABETH (MFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 E WASHINGTON BLVD
Mailing Address - Street 2:APT. 15
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2513
Mailing Address - Country:US
Mailing Address - Phone:626-794-6663
Mailing Address - Fax:
Practice Address - Street 1:37 AUBURN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1844
Practice Address - Country:US
Practice Address - Phone:626-298-1177
Practice Address - Fax:626-355-3424
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist