Provider Demographics
NPI:1114324035
Name:PORTER, GAYLE (LPCC)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:ELLEN
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:2676 MARICOPA DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3948
Mailing Address - Country:US
Mailing Address - Phone:505-225-2996
Mailing Address - Fax:
Practice Address - Street 1:2676 MARICOPA DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3948
Practice Address - Country:US
Practice Address - Phone:505-225-2996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0194821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health