Provider Demographics
NPI:1912244153
Name:PORTER, TANGENISE SHARANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TANGENISE
Middle Name:SHARANE
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 1:6449 S GREENWOOD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637
Mailing Address - Country:US
Mailing Address - Phone:773-934-8359
Mailing Address - Fax:
Practice Address - Street 1:15900 S CICERO BUILDING B12
Practice Address - Street 2:OAK FOREST HOSPITAL
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452
Practice Address - Country:US
Practice Address - Phone:708-633-2581
Practice Address - Fax:708-633-2034
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health