Provider Demographics
NPI:1851515332
Name:PORTER, LARRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:CRAIG
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2229 S PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-5141
Mailing Address - Country:US
Mailing Address - Phone:605-929-1060
Mailing Address - Fax:801-904-0104
Practice Address - Street 1:6820 W 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-4554
Practice Address - Country:US
Practice Address - Phone:605-929-1060
Practice Address - Fax:801-904-1060
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1176106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist