Provider Demographics
NPI:1346540085
Name:PORTER, LANE CANNON (CMHC)
Entity Type:Individual
Prefix:MR
First Name:LANE
Middle Name:CANNON
Last Name:PORTER
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 E CAROLINE DAY CV
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5164
Mailing Address - Country:US
Mailing Address - Phone:801-577-4804
Mailing Address - Fax:
Practice Address - Street 1:2973 W 13800 S
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-8202
Practice Address - Country:US
Practice Address - Phone:801-577-4804
Practice Address - Fax:844-965-9279
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7960484-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health