Provider Demographics
NPI:1023474517
Name:STERKHOVA-ORTIZ, EKATERINA V (LMLP)
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:V
Last Name:STERKHOVA-ORTIZ
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N JEFFERSON AVE
Mailing Address - Street 2:PO BOX 807
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-2327
Mailing Address - Country:US
Mailing Address - Phone:620-365-8641
Mailing Address - Fax:620-365-8642
Practice Address - Street 1:519 S ELM ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1420
Practice Address - Country:US
Practice Address - Phone:785-448-6806
Practice Address - Fax:785-448-6960
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2620103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical