Provider Demographics
NPI:1851008254
Name:PORTER, JORDAN RAY (LBA/BCBA)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:RAY
Last Name:PORTER
Suffix:
Gender:M
Credentials:LBA/BCBA
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Mailing Address - Street 1:2353 BADGER STREET
Mailing Address - Street 2:FUNCTIONAL BEHAVIOR SERVICES
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2303
Mailing Address - Country:US
Mailing Address - Phone:906-273-1121
Mailing Address - Fax:906-225-6706
Practice Address - Street 1:2353 BADGER STREET
Practice Address - Street 2:FUNCTIONAL BEHAVIOR SERVICES
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2303
Practice Address - Country:US
Practice Address - Phone:906-273-1121
Practice Address - Fax:906-225-6706
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI7401002227103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst