Provider Demographics
NPI:1407337892
Name:PORRAS, AMANDA MICHELLE (LMFT-RPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:PORRAS
Suffix:
Gender:F
Credentials:LMFT-RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 W 33RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3834
Mailing Address - Country:US
Mailing Address - Phone:405-875-5399
Mailing Address - Fax:
Practice Address - Street 1:1721 W 33RD ST STE B
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3834
Practice Address - Country:US
Practice Address - Phone:405-875-5399
Practice Address - Fax:405-562-3532
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1396106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist