Provider Demographics
NPI:1013932425
Name:PORTER, LEE W (NP, CNS-PMH)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:W
Last Name:PORTER
Suffix:
Gender:M
Credentials:NP, CNS-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DIVISION AVE UNIT 299
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2485
Mailing Address - Country:US
Mailing Address - Phone:541-896-1555
Mailing Address - Fax:888-562-3550
Practice Address - Street 1:5305 RIVER RD N STE B
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5324
Practice Address - Country:US
Practice Address - Phone:541-896-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202002489CNS-PP208VP0000X, 364SP0809X, 364SP0813X, 363LP0808X
NC1635522084N0600X
OR201501835NP-PP363LA2200X, 364SP0808X, 364SP0811X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0811XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Chronically Ill
No364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3072541580OtherPECOS PAC ID
ORI20160510002557OtherPECOS PAC ENROLLMENT ID
NC131VXOtherBLUE CROSS PROVIDER ID
OR500709395Medicaid
NC131VXOtherBLUE CROSS PROVIDER ID