Provider Demographics
NPI:1023412764
Name:PORTER, CHELSA (ED S)
Entity type:Individual
Prefix:
First Name:CHELSA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MC ARTHUR
Mailing Address - State:OH
Mailing Address - Zip Code:45651-1093
Mailing Address - Country:US
Mailing Address - Phone:740-596-5218
Mailing Address - Fax:
Practice Address - Street 1:307 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MC ARTHUR
Practice Address - State:OH
Practice Address - Zip Code:45651-1093
Practice Address - Country:US
Practice Address - Phone:740-596-5218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3151546103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool