Provider Demographics
NPI:1023254661
Name:PORTER, RUBY TOLIVER (LMSW)
Entity type:Individual
Prefix:MS
First Name:RUBY
Middle Name:TOLIVER
Last Name:PORTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6039 HEFFERNAN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-5015
Mailing Address - Country:US
Mailing Address - Phone:713-641-3924
Mailing Address - Fax:713-641-3924
Practice Address - Street 1:6039 HEFFERNAN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-5015
Practice Address - Country:US
Practice Address - Phone:713-641-3924
Practice Address - Fax:713-641-3924
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-04
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03893171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator