Provider Demographics
NPI:1285376640
Name:ORTEGA, NINA (MA, LPC)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 W MARQUETTE RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2958
Mailing Address - Country:US
Mailing Address - Phone:773-629-1208
Mailing Address - Fax:
Practice Address - Street 1:3050 W MARQUETTE RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2958
Practice Address - Country:US
Practice Address - Phone:773-629-1208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178017787101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor