Provider Demographics
NPI:1407438153
Name:PORTER, KRISTIN NOEL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NOEL
Last Name:PORTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2172
Mailing Address - Country:US
Mailing Address - Phone:817-922-6000
Mailing Address - Fax:
Practice Address - Street 1:6300 JOHN RYAN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4122
Practice Address - Country:US
Practice Address - Phone:817-922-6083
Practice Address - Fax:817-922-5955
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX594011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX59401OtherTEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL