Provider Demographics
NPI:1518053461
Name:CORTEZ, STEVE GLENN (LCSW)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:GLENN
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 WOLF CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5361
Mailing Address - Country:US
Mailing Address - Phone:916-883-0935
Mailing Address - Fax:
Practice Address - Street 1:12500 BRUCEVILLE RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-9784
Practice Address - Country:US
Practice Address - Phone:916-684-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS17546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health