Provider Demographics
NPI:1881902138
Name:PORTER, LESA E (LPC)
Entity type:Individual
Prefix:MRS
First Name:LESA
Middle Name:E
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2074
Mailing Address - Country:US
Mailing Address - Phone:708-677-5621
Mailing Address - Fax:708-816-1717
Practice Address - Street 1:6325 VIRGINIA LN
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2074
Practice Address - Country:US
Practice Address - Phone:708-677-5621
Practice Address - Fax:708-816-1717
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health