| Doctor Name: | THERESA ORTIZ |
| NPI Number: | 1104236694 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | M-08152 |
| Business Practice Address: | 1043 Highway 313 Bernalillo, NM - 870046912 |
| Business Phone Number: | 5058673351 |
| Business Fax Number: | 5058673514 |
| Mailing Address: | 10619 Virgo St Nw, ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871143661 |
| Phone Number: | 5053664942 |
| Fax Number: | |
| NPI Enumeration Date: | 05/06/2014 |
| NPI Last Update Date: | 05/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | M-08152 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |