Provider Demographics
NPI:1417459538
Name:PORTER, TANYA T (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:T
Last Name:PORTER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 WRIGHT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2226
Mailing Address - Country:US
Mailing Address - Phone:337-514-5181
Mailing Address - Fax:337-514-5182
Practice Address - Street 1:108 EXCHANGE PL STE 290
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2558
Practice Address - Country:US
Practice Address - Phone:337-541-2689
Practice Address - Fax:337-777-1577
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
LA8201101YP2500X, 101YP2500X
LAPLC8201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty