Provider Demographics
NPI:1568283240
Name:ORTIZ, CARMEN (CADC, CRM)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:CADC, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SW CEDAR HILLS BLVD
Mailing Address - Street 2:STE 170
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005
Mailing Address - Country:US
Mailing Address - Phone:503-626-1800
Mailing Address - Fax:503-200-1192
Practice Address - Street 1:3800 SW CEDAR HILLS BLVD
Practice Address - Street 2:STE 170
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-626-1800
Practice Address - Fax:503-200-1192
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-24-4413101YA0400X
OR18-CRM-197175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR18-CRM-197OtherMHACBO CRM
ORT-24-4413OtherMHACBO CADC