Provider Demographics
NPI:1194001024
Name:PORTER, WILLIAM (LPC-S)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:9104 MANANA ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6043
Mailing Address - Country:US
Mailing Address - Phone:817-734-4167
Mailing Address - Fax:
Practice Address - Street 1:6300 JOHN RYAN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4122
Practice Address - Country:US
Practice Address - Phone:817-922-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64729101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285355802Medicaid