Provider Demographics
NPI:1689437618
Name:ORTIZ, JORGE HUMBERTO (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:HUMBERTO
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15835 FOOTHILL FARMS LOOP APT 333
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3233
Mailing Address - Country:US
Mailing Address - Phone:409-344-1931
Mailing Address - Fax:
Practice Address - Street 1:500 N CAPITAL OF TEXAS HWY STE 117
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-3302
Practice Address - Country:US
Practice Address - Phone:512-552-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional