Provider Demographics
NPI:1912649526
Name:PORTER, ENDEYA MONET
Entity Type:Individual
Prefix:
First Name:ENDEYA
Middle Name:MONET
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 GRAHAM ST APT 8
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-2342
Mailing Address - Country:US
Mailing Address - Phone:810-835-8860
Mailing Address - Fax:
Practice Address - Street 1:621 GRAHAM ST APT 8
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2342
Practice Address - Country:US
Practice Address - Phone:810-835-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst