Provider Demographics
NPI:1619566908
Name:PORTER, MICHAEL (LMFT ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:LMFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S HARRIS ST STE 238
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6086
Mailing Address - Country:US
Mailing Address - Phone:512-591-8428
Mailing Address - Fax:
Practice Address - Street 1:106 S HARRIS ST STE 238
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6086
Practice Address - Country:US
Practice Address - Phone:512-591-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203868106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health