Provider Demographics
NPI:1891034955
Name:ORTIZ, THERESA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:JEAN
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:JEAN
Other - Last Name:BAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8105 W 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-3372
Mailing Address - Country:US
Mailing Address - Phone:303-463-4747
Mailing Address - Fax:
Practice Address - Street 1:8105 W 65TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-3372
Practice Address - Country:US
Practice Address - Phone:303-463-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-10
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9899121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical