Provider Demographics
NPI:1609838069
Name:ORTIZ, GLORIA L (LPC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:L
Last Name:ORTIZ
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 1:203 N AVENUE C
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78839-3550
Mailing Address - Country:US
Mailing Address - Phone:830-374-9191
Mailing Address - Fax:
Practice Address - Street 1:203 N AVENUE C
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-3550
Practice Address - Country:US
Practice Address - Phone:830-374-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20004101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84860LOtherBLUE CROSS BLUE SHIELD
TX177998501Medicaid