Provider Demographics
NPI:1760186639
Name:ORTIZ-REICH, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ORTIZ-REICH
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 1:5000 BASSETT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4174
Mailing Address - Country:US
Mailing Address - Phone:612-940-8354
Mailing Address - Fax:
Practice Address - Street 1:1600 UNIVERSITY AVE W STE 203
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3838
Practice Address - Country:US
Practice Address - Phone:651-645-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305193101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)