Provider Demographics
NPI:1386920403
Name:ORTIZ, EDUARDO ANTONIO (LCDC)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:ANTONIO
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BUSINESS DR W
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4326
Mailing Address - Country:US
Mailing Address - Phone:830-367-4667
Mailing Address - Fax:830-367-4687
Practice Address - Street 1:102 BUSINESS DR W
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4326
Practice Address - Country:US
Practice Address - Phone:830-367-4667
Practice Address - Fax:830-367-4687
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9762101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)