Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 76296 | TX |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 76296 | TX |
N | 101YM0800X | Mental Health Counselor | 76296 | TX |
N | 101YP1600X | Pastoral Counselor | 76296 | TX |
N | 101YS0200X | School Counselor | 76296 | TX |
NPI | 1093205296 |
---|---|
Provider Name | Melissa Nicole Ortiz |
First Address | San Antonio, TX 78223-1420 |
Second Address | San Antonio, TX 78223-1420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2018 |
Last Update Date | 14/05/2018 |