Provider Demographics
NPI:1942613096
Name:ORTNER, ADAM (LPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ORTNER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 PLUMAS CT
Mailing Address - Street 2:#C
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-2971
Mailing Address - Country:US
Mailing Address - Phone:530-751-9903
Mailing Address - Fax:530-751-9932
Practice Address - Street 1:1525 PLUMAS CT
Practice Address - Street 2:#C
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2971
Practice Address - Country:US
Practice Address - Phone:530-751-9903
Practice Address - Fax:530-751-9932
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health