Provider Demographics
NPI:1285024406
Name:PORTER, CORI A (PLADC)
Entity Type:Individual
Prefix:MS
First Name:CORI
Middle Name:A
Last Name:PORTER
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E 22ND ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2661
Mailing Address - Country:US
Mailing Address - Phone:402-932-2248
Mailing Address - Fax:402-932-3557
Practice Address - Street 1:230 E 22ND ST
Practice Address - Street 2:SUITE 4
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2661
Practice Address - Country:US
Practice Address - Phone:402-932-2248
Practice Address - Fax:402-932-3557
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1267101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)