Provider Demographics
NPI:1801638069
Name:ORTEGA, CARLOS ALEXIS (LPC-IT)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALEXIS
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W WISCONSIN AVE
Mailing Address - Street 2:STE 202 PMB 1071
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:606 W WISCONSIN AVE
Practice Address - Street 2:STE 202 PMB 1071
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203
Practice Address - Country:US
Practice Address - Phone:414-375-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5430-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional