Healthcare Provider Details

I. General information

NPI: 1265508733
Provider Name (Legal Business Name): HOWARD CHANDLER PORTER II ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HOWARD CHANDLER PORTER II ACSW

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 CEDAR STREET
PARADISE CA
95969
US

IV. Provider business mailing address

625 BILLE RD
PARADISE CA
95969-3043
US

V. Phone/Fax

Practice location:
  • Phone: 530-877-5845
  • Fax: 530-877-3976
Mailing address:
  • Phone: 530-877-4893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: