Provider Demographics
NPI:1558573253
Name:ORTIZ, STACY R (MS, LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MS, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MAIN ST STE 115
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2211
Mailing Address - Country:US
Mailing Address - Phone:316-992-0355
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2211
Practice Address - Country:US
Practice Address - Phone:316-992-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional