Provider Demographics
NPI:1700610151
Name:PORTRA, LEXTYN H (LMSW)
Entity type:Individual
Prefix:
First Name:LEXTYN
Middle Name:H
Last Name:PORTRA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5211
Mailing Address - Country:US
Mailing Address - Phone:701-300-0019
Mailing Address - Fax:
Practice Address - Street 1:2201 36TH AVE SW STE B
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7593
Practice Address - Country:US
Practice Address - Phone:701-837-9801
Practice Address - Fax:701-483-0060
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical