Provider Demographics
NPI:1295557346
Name:PORTILLO, MARIA FERNANDA (MS, T-LMFT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:MS, T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 N 11TH ST APT J
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5487
Mailing Address - Country:US
Mailing Address - Phone:512-354-6705
Mailing Address - Fax:
Practice Address - Street 1:4201 ANDERSON AVE STE D110
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7603
Practice Address - Country:US
Practice Address - Phone:785-539-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist