Provider Demographics
NPI:1669919593
Name:PORTER, GLEN (CMHC)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:PORTER
Suffix:
Gender:
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 S AERIES DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-3568
Mailing Address - Country:US
Mailing Address - Phone:801-499-9435
Mailing Address - Fax:
Practice Address - Street 1:85 N 300 W STE C
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-3563
Practice Address - Country:US
Practice Address - Phone:435-227-5052
Practice Address - Fax:435-215-4514
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9823173-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health