Provider Demographics
NPI:1598496945
Name:ORTIZ, MICHELLE NATHALIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NATHALIE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5922 CLIFFBRIER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-4901
Mailing Address - Country:US
Mailing Address - Phone:210-838-0144
Mailing Address - Fax:
Practice Address - Street 1:5922 CLIFFBRIER DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-4901
Practice Address - Country:US
Practice Address - Phone:210-838-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical