Provider Demographics
NPI:1891578415
Name:ORTIZ, GEORGINA M (LMFT)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:M
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91319-0248
Mailing Address - Country:US
Mailing Address - Phone:805-210-1026
Mailing Address - Fax:
Practice Address - Street 1:5743 CORSA AVE STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-7312
Practice Address - Country:US
Practice Address - Phone:818-889-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist