Provider Demographics
NPI:1255515003
Name:ORT, DOUGLAS H II (LMHC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:H
Last Name:ORT
Suffix:II
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3209
Mailing Address - Country:US
Mailing Address - Phone:315-785-5668
Mailing Address - Fax:315-785-5668
Practice Address - Street 1:125 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3209
Practice Address - Country:US
Practice Address - Phone:315-785-5668
Practice Address - Fax:315-785-5668
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003732-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health