Provider Demographics
NPI:1770843757
Name:PORTER, JAMIE LYNN (MA, LMFT, LPX)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LYNN
Last Name:PORTER
Suffix:
Gender:F
Credentials:MA, LMFT, LPX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 BROADWAY ST
Mailing Address - Street 2:SUITE 2743
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9785
Mailing Address - Country:US
Mailing Address - Phone:832-736-4418
Mailing Address - Fax:
Practice Address - Street 1:11200 BROADWAY ST
Practice Address - Street 2:SUITE 2743
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9785
Practice Address - Country:US
Practice Address - Phone:832-736-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64674101YP2500X
TX201362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional