Provider Demographics
NPI:1568486363
Name:PORTA, LAWRENCE JOSEPH (LMHC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:PORTA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:J
Other - Last Name:PORTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:512 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3247
Mailing Address - Country:US
Mailing Address - Phone:231-941-6550
Mailing Address - Fax:231-941-8981
Practice Address - Street 1:512 S UNION ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3247
Practice Address - Country:US
Practice Address - Phone:231-941-6550
Practice Address - Fax:231-941-8981
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5902101YP2500X
MI6401013035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional