Healthcare Provider Details

I. General information

NPI: 1780110981
Provider Name (Legal Business Name): HEATHER LYNN PORTER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2017
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W REDLANDS BLVD STE B
REDLANDS CA
92373-4642
US

IV. Provider business mailing address

501 W REDLANDS BLVD STE B
REDLANDS CA
92373-4642
US

V. Phone/Fax

Practice location:
  • Phone: 909-686-6233
  • Fax: 909-494-7562
Mailing address:
  • Phone: 909-686-6233
  • Fax: 909-353-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF98060
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT119623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: