Provider Demographics
NPI:1265028989
Name:PORTER, RALPH A (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:A
Last Name:PORTER
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 FAIR OAKS PKWY STE 3201
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-5134
Mailing Address - Country:US
Mailing Address - Phone:830-446-3155
Mailing Address - Fax:
Practice Address - Street 1:8000 FAIR OAKS PKWY STE 3201
Practice Address - Street 2:
Practice Address - City:FAIR OAKS RANCH
Practice Address - State:TX
Practice Address - Zip Code:78015-5134
Practice Address - Country:US
Practice Address - Phone:830-446-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15067101YA0400X
TX82166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)