Provider Demographics
NPI:1487462446
Name:ORTIZ, NICHOLAS ORION (LPC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ORION
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HITCHING POST LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-1537
Mailing Address - Country:US
Mailing Address - Phone:717-715-3772
Mailing Address - Fax:
Practice Address - Street 1:120 FOXSHIRE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3982
Practice Address - Country:US
Practice Address - Phone:717-431-6615
Practice Address - Fax:717-618-0498
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017957101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional