Provider Demographics
NPI:1639380116
Name:GOYETTE, PORTIA RILEY (LMFT, DCC)
Entity Type:Individual
Prefix:
First Name:PORTIA
Middle Name:RILEY
Last Name:GOYETTE
Suffix:
Gender:F
Credentials:LMFT, DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DAIRY RD STE E224
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2348
Mailing Address - Country:US
Mailing Address - Phone:808-212-5348
Mailing Address - Fax:
Practice Address - Street 1:415 DAIRY RD STE E224
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2348
Practice Address - Country:US
Practice Address - Phone:503-567-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1315106H00000X
WALF60707416106H00000X
HIMFT-516106H00000X
106H00000X
WAMG60491005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist