Provider Demographics
NPI:1508241910
Name:PORTER, JACQUELINE HOWZE (BA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:HOWZE
Last Name:PORTER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 TAMMY DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6474
Mailing Address - Country:US
Mailing Address - Phone:985-210-3015
Mailing Address - Fax:
Practice Address - Street 1:139 TAMMY DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-6474
Practice Address - Country:US
Practice Address - Phone:985-210-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health