Provider Demographics
NPI:1639590748
Name:PORTENGA, STEVEN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:T
Last Name:PORTENGA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 INVERNESS CIR E
Mailing Address - Street 2:A207
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5304
Mailing Address - Country:US
Mailing Address - Phone:303-960-5711
Mailing Address - Fax:
Practice Address - Street 1:88 INVERNESS CIR E
Practice Address - Street 2:A207
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5304
Practice Address - Country:US
Practice Address - Phone:303-960-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2922103TC1900X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling