Provider Demographics
NPI:1447609797
Name:PORTER, KRYSTIN L (LPC, LMFT, NCC)
Entity Type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29019 FOX FOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3097
Mailing Address - Country:US
Mailing Address - Phone:832-434-4443
Mailing Address - Fax:
Practice Address - Street 1:29019 FOX FOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-3097
Practice Address - Country:US
Practice Address - Phone:832-434-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71418101YP2500X
TX202147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist