Provider Demographics
NPI:1144778671
Name:STEPHANIE PORTER
Entity Type:Organization
Organization Name:STEPHANIE PORTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAMFT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:505-453-6235
Mailing Address - Street 1:320 OSUNA RD NE
Mailing Address - Street 2:STE H-4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5952
Mailing Address - Country:US
Mailing Address - Phone:505-345-2778
Mailing Address - Fax:
Practice Address - Street 1:320 OSUNA RD NE
Practice Address - Street 2:STE H-4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5952
Practice Address - Country:US
Practice Address - Phone:505-345-2778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0182791251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health