Provider Demographics
NPI:1841341138
Name:PORTER, DAVID K (LMHC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:K
Last Name:PORTER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 BRINSON RD
Mailing Address - Street 2:APT. #3205
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-3023
Mailing Address - Country:US
Mailing Address - Phone:813-948-4159
Mailing Address - Fax:425-962-4159
Practice Address - Street 1:1532 LAND O LAKES BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-2936
Practice Address - Country:US
Practice Address - Phone:813-948-4159
Practice Address - Fax:425-962-4159
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5225101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health