Provider Demographics
NPI:1730258435
Name:ORTIZ, DIRCE (LPC)
Entity type:Individual
Prefix:MRS
First Name:DIRCE
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 1:2855 MANGUM RD STE 572
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-7553
Mailing Address - Country:US
Mailing Address - Phone:832-951-3685
Mailing Address - Fax:281-741-3861
Practice Address - Street 1:2855 MANGUM RD STE 572
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-7553
Practice Address - Country:US
Practice Address - Phone:832-951-3685
Practice Address - Fax:281-741-3861
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16691101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175823702Medicaid