Basic Information
| Provider Information | |||||||||
| NPI: | 1184260861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | BRYANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1638 W ALABAMA ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770064102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323875735 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1638 W ALABAMA ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770064102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323875735 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2019 | ||||||||
| LastUpdateDate: | 11/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 82453 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.