Provider Demographics
NPI:1629624606
Name:ORTIZ-RODRIGUEZ, SAMUEL ANTONIO (LPC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ANTONIO
Last Name:ORTIZ-RODRIGUEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 SYLVAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2031
Mailing Address - Country:US
Mailing Address - Phone:214-333-7060
Mailing Address - Fax:214-630-3469
Practice Address - Street 1:1330 RIVER BEND DR STE 850
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4953
Practice Address - Country:US
Practice Address - Phone:214-333-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82119101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health