Provider Demographics
NPI:1235365487
Name:PORTER STARKE SERVICES
Entity Type:Organization
Organization Name:PORTER STARKE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LJUBICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, LCAC
Authorized Official - Phone:219-476-4533
Mailing Address - Street 1:729 COYOTE TRL
Mailing Address - Street 2:
Mailing Address - City:KOUTS
Mailing Address - State:IN
Mailing Address - Zip Code:46347-9305
Mailing Address - Country:US
Mailing Address - Phone:219-743-2815
Mailing Address - Fax:
Practice Address - Street 1:601 WALL ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2512
Practice Address - Country:US
Practice Address - Phone:219-531-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health