Provider Demographics
NPI:1578909370
Name:PORTMAN, PHILIP RAMON (MS)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:RAMON
Last Name:PORTMAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35005-2365
Mailing Address - Country:US
Mailing Address - Phone:205-370-5487
Mailing Address - Fax:
Practice Address - Street 1:116 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35005-2365
Practice Address - Country:US
Practice Address - Phone:205-370-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health