Provider Demographics
NPI:1023460821
Name:PORTNER COUNSELING GROUP
Entity type:Organization
Organization Name:PORTNER COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-895-6263
Mailing Address - Street 1:1800 N FEDERAL HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1034
Mailing Address - Country:US
Mailing Address - Phone:954-895-6263
Mailing Address - Fax:239-775-0088
Practice Address - Street 1:1800 N FEDERAL HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1034
Practice Address - Country:US
Practice Address - Phone:954-895-6263
Practice Address - Fax:239-775-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1706AD859301101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1706AD859301OtherSTATE DCF LICENSE