Provider Demographics
NPI:1821273467
Name:LORENZO ORTIZ DBA WINTERGARDEN COUNSELING SERVICES
Entity Type:Organization
Organization Name:LORENZO ORTIZ DBA WINTERGARDEN COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:830-374-9191
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177998501Medicaid
TX027823601Medicaid
TX84860LOtherBLUE CROSS BLUE SHIELD
TX82303LOtherBLUE CROSS BLUE SHIELD