Provider Demographics
NPI:1235853755
Name:PORTER, LISA MARY (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:MARY
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LISE
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3940 LAUREL CANYON BLVD # 484
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3709
Mailing Address - Country:US
Mailing Address - Phone:619-838-3888
Mailing Address - Fax:
Practice Address - Street 1:1245 5TH ST APT 3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2232
Practice Address - Country:US
Practice Address - Phone:619-838-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist