Provider Demographics
NPI:1841664141
Name:ORTIZ, CRYSTAL CELESTE (LPCC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CELESTE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E MERCED ST
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CA
Mailing Address - Zip Code:93625-2316
Mailing Address - Country:US
Mailing Address - Phone:559-205-4035
Mailing Address - Fax:
Practice Address - Street 1:311 E MERCED ST
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CA
Practice Address - Zip Code:93625-2316
Practice Address - Country:US
Practice Address - Phone:555-892-9452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3997101Y00000X, 101YM0800X
390200000X
CALPCC14129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program