Provider Demographics
NPI:1609302124
Name:PORTER'S HOUSE FOR HEALING COMMUNITY COUNSELING SERVICES
Entity Type:Organization
Organization Name:PORTER'S HOUSE FOR HEALING COMMUNITY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-315-0394
Mailing Address - Street 1:2906 EDGEWICK ELM ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8131
Mailing Address - Country:US
Mailing Address - Phone:713-315-0394
Mailing Address - Fax:
Practice Address - Street 1:2906 EDGEWICK ELM ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8131
Practice Address - Country:US
Practice Address - Phone:713-315-0394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health