Provider Demographics
NPI:1740993690
Name:PORTER, SHAY-LYN (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:SHAY-LYN
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13903 EVELINA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4416
Mailing Address - Country:US
Mailing Address - Phone:210-801-5222
Mailing Address - Fax:
Practice Address - Street 1:13903 EVELINA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-4416
Practice Address - Country:US
Practice Address - Phone:210-801-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty