Provider Demographics
NPI:1124640180
Name:PORTER, ALEXSANDRA LYNN
Entity type:Individual
Prefix:
First Name:ALEXSANDRA
Middle Name:LYNN
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXSANDRA
Other - Middle Name:LYNN
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4149 24TH AVE SE APT 3
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-0842
Mailing Address - Country:US
Mailing Address - Phone:570-328-1993
Mailing Address - Fax:
Practice Address - Street 1:320 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5238
Practice Address - Country:US
Practice Address - Phone:405-573-3819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health