MEDICARE: MARK PORTERFIELD MA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	T1889	OR
2	106H00000X	Marriage & Family Therapist	MT4384	FL

General Provider Information

NPI Number	:	1730616137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK PORTERFIELD MA, LMFT

Provider Business Mailing Address
First Line	:	3848 FLATIRON LOOP UNIT 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7825
Country	:	US
Telephone Number	:	352-737-2199
Fax Number	:

Provider Business Practice Location Address
First Line	:	3848 FLATIRON LOOP UNIT 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7825
Country	:	US
Telephone Number	:	727-353-2317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2017
Last Update Date	:	09/13/2022

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