Provider Demographics
NPI:1831846492
Name:PORTER, MARY BETH (MA, LCDC, LPC ASSOC)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:MA, LCDC, LPC ASSOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S ALAMEDA ST STE 150
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2949
Mailing Address - Country:US
Mailing Address - Phone:361-854-9199
Mailing Address - Fax:
Practice Address - Street 1:1801 S ALAMEDA ST STE 150
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2949
Practice Address - Country:US
Practice Address - Phone:361-854-9199
Practice Address - Fax:361-854-9147
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89986101YP2500X
TX15740101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional