Provider Demographics
NPI:1942909387
Name:PORTER, JAMES BENNETT KLINGER
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BENNETT KLINGER
Last Name:PORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:BENNETT KLINGER
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4468 POWELL LN
Mailing Address - Street 2:
Mailing Address - City:KEWADIN
Mailing Address - State:MI
Mailing Address - Zip Code:49648-9339
Mailing Address - Country:US
Mailing Address - Phone:248-535-5095
Mailing Address - Fax:
Practice Address - Street 1:1810 CHARTWELL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-9283
Practice Address - Country:US
Practice Address - Phone:231-929-2354
Practice Address - Fax:231-929-2853
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician