Provider Demographics
NPI:1831336874
Name:ORTIZ, TYSON N (LMHC)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:N
Last Name:ORTIZ
Suffix:
Gender:F
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:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:HI
Mailing Address - Zip Code:96771-0177
Mailing Address - Country:US
Mailing Address - Phone:808-464-1655
Mailing Address - Fax:808-464-1655
Practice Address - Street 1:191 MOHOULI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3949
Practice Address - Country:US
Practice Address - Phone:808-464-1655
Practice Address - Fax:808-464-1655
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-1019-0101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional