Provider Demographics
NPI:1427867738
Name:ORTEGA, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 S FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2117
Mailing Address - Country:US
Mailing Address - Phone:425-218-6434
Mailing Address - Fax:
Practice Address - Street 1:12345 LAKE CITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5401
Practice Address - Country:US
Practice Address - Phone:253-234-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health