Provider Demographics
NPI:1184391468
Name:ORTIZ, GISELLE (LPC)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29707 W WHITTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-3109
Mailing Address - Country:US
Mailing Address - Phone:928-241-4367
Mailing Address - Fax:
Practice Address - Street 1:3125 S PRICE RD STE 122
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3547
Practice Address - Country:US
Practice Address - Phone:480-772-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health