Healthcare Provider Details

I. General information

NPI: 1730616137
Provider Name (Legal Business Name): MARK PORTERFIELD MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N CLOVERDALE RD STE 204
BOISE ID
83713-1068
US

IV. Provider business mailing address

4700 N CLOVERDALE RD STE 204
BOISE ID
83713-1068
US

V. Phone/Fax

Practice location:
  • Phone: 727-353-2317
  • Fax:
Mailing address:
  • Phone: 727-353-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4384
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4071084
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1889
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: