MEDICARE: ALEC PORTER

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1942851027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEC PORTER

Provider Business Mailing Address
First Line	:	1290 GAINESBORO GRADE APT F2
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-0763
Country	:	US
Telephone Number	:	731-334-1379
Fax Number	:

Provider Business Practice Location Address
First Line	:	6339 CHARLOTTE PIKE # 696
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-2926
Country	:	US
Telephone Number	:	407-801-9924
Fax Number	:

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

Provider Enumeration Date	:	09/20/2019
Last Update Date	:	09/20/2019

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Directions to “ ALEC PORTER ” Practice Location

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