Provider Demographics
NPI:1487432225
Name:ORTEGA, LISSETTE Q (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:LISSETTE
Middle Name:Q
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SHADOWDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2608
Mailing Address - Country:US
Mailing Address - Phone:713-251-1741
Mailing Address - Fax:713-251-9123
Practice Address - Street 1:2100 SHADOWDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2608
Practice Address - Country:US
Practice Address - Phone:713-251-1741
Practice Address - Fax:713-251-9123
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72060103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool