Provider Demographics
NPI:1649068941
Name:PORTER, KENNITH SR (CCHT)
Entity type:Individual
Prefix:
First Name:KENNITH
Middle Name:
Last Name:PORTER
Suffix:SR
Gender:
Credentials:CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-6810
Mailing Address - Country:US
Mailing Address - Phone:504-402-1814
Mailing Address - Fax:
Practice Address - Street 1:1101 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-6810
Practice Address - Country:US
Practice Address - Phone:504-250-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional