Provider Demographics
NPI:1932308483
Name:LUSTIG ORTIZ, CHRISTINE MICHELLE (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MICHELLE
Last Name:LUSTIG ORTIZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 PACIFIC COAST HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6650
Mailing Address - Country:US
Mailing Address - Phone:562-230-4932
Mailing Address - Fax:562-684-0739
Practice Address - Street 1:610 PACIFIC COAST HWY STE 205
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6650
Practice Address - Country:US
Practice Address - Phone:562-230-4932
Practice Address - Fax:562-684-0739
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47918106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist