Provider Demographics
NPI:1538022058
Name:ORTEGA, ELIAS (LLPC,LLMFT)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:LLPC,LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W MARS ST
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1134
Mailing Address - Country:US
Mailing Address - Phone:269-338-5887
Mailing Address - Fax:
Practice Address - Street 1:3133 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2647
Practice Address - Country:US
Practice Address - Phone:269-588-3167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151001208106H00000X
MI6451024748101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist