Provider Demographics
NPI:1083171169
Name:PORTER, ELISABETH (MFT)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:519 OLD TOWNE DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4454
Mailing Address - Country:US
Mailing Address - Phone:206-817-4793
Mailing Address - Fax:
Practice Address - Street 1:2021 21ST AVE S STE 430
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4346
Practice Address - Country:US
Practice Address - Phone:615-933-9318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1473106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist