Provider Demographics
NPI:1326673526
Name:PORTER, NATASHA REGINA (PHD, LMFT, LPCC-S)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:REGINA
Last Name:PORTER
Suffix:
Gender:F
Credentials:PHD, LMFT, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W DIXIE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1764
Mailing Address - Country:US
Mailing Address - Phone:270-900-1358
Mailing Address - Fax:844-444-1150
Practice Address - Street 1:300 W DIXIE AVE STE 11
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1764
Practice Address - Country:US
Practice Address - Phone:270-900-1358
Practice Address - Fax:844-444-1150
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4317106H00000X
KY247969101YP2500X
OHF2100220106H00000X
KY262289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0464336Medicaid
KY7100670980Medicaid