Provider Demographics
NPI:1003215609
Name:ORTEGA, IVONNE MARINA (LPCC16302)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:MARINA
Last Name:ORTEGA
Suffix:
Gender:
Credentials:LPCC16302
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 SUN VALLEY DR TRLR 213
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-3540
Mailing Address - Country:US
Mailing Address - Phone:619-600-9614
Mailing Address - Fax:
Practice Address - Street 1:6111 SUN VALLEY DR TRLR 213
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-3540
Practice Address - Country:US
Practice Address - Phone:619-600-9614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC16302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional