Provider Demographics
NPI:1639539588
Name:PORTNER, MATT (LPC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:
Last Name:PORTNER
Suffix:
Gender:M
Credentials:LPC, LMHC
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:L
Other - Last Name:PORTNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LMHC
Mailing Address - Street 1:6926 NE FOURTH PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7254
Mailing Address - Country:US
Mailing Address - Phone:360-993-3000
Mailing Address - Fax:
Practice Address - Street 1:6926 NE FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7254
Practice Address - Country:US
Practice Address - Phone:360-993-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61166605101YP2500X
ORC5373101YP2500X
VA0701006464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional