Provider Demographics
NPI:1992571012
Name:ORTIZ PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:ORTIZ PROFESSIONAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAVILA ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHC, CADC
Authorized Official - Phone:904-523-1287
Mailing Address - Street 1:250 CHERRY RIDGE DR APT 1219
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-2870
Mailing Address - Country:US
Mailing Address - Phone:904-523-1287
Mailing Address - Fax:904-615-6919
Practice Address - Street 1:1857 WELLS RD STE 2016
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2338
Practice Address - Country:US
Practice Address - Phone:904-523-1287
Practice Address - Fax:904-615-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health