Provider Demographics
NPI:1508379165
Name:CORTEZ, MICHELLE ANGELICA (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGELICA
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 GEORGE DIETER DR STE 140
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7430
Mailing Address - Country:US
Mailing Address - Phone:915-320-1390
Mailing Address - Fax:915-857-5182
Practice Address - Street 1:1390 GEORGE DIETER DR STE 140
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7430
Practice Address - Country:US
Practice Address - Phone:915-320-1390
Practice Address - Fax:915-857-5182
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional