Healthcare Provider Details

I. General information

NPI: 1689376600
Provider Name (Legal Business Name): HOPE PORTER MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S VAN BUREN ST
NEWTON IL
62448-1727
US

IV. Provider business mailing address

106 EDWARDS ST
NEWTON IL
62448-1736
US

V. Phone/Fax

Practice location:
  • Phone: 618-783-4154
  • Fax:
Mailing address:
  • Phone: 618-783-4154
  • Fax: 618-783-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: