Provider Demographics
NPI:1689948275
Name:ORTEGA, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 N YARBROUGH DR
Mailing Address - Street 2:SUITE A4
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3101
Mailing Address - Country:US
Mailing Address - Phone:915-775-2722
Mailing Address - Fax:915-783-5786
Practice Address - Street 1:6314 DELTA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-5406
Practice Address - Country:US
Practice Address - Phone:915-775-2722
Practice Address - Fax:915-783-5786
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM014661101YM0800X
TX73809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health