Healthcare Provider Details

I. General information

NPI: 1508902560
Provider Name (Legal Business Name): YVONNE L PORTER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 WILLOW ST
VINCENNES IN
47591-4277
US

IV. Provider business mailing address

PO BOX 556
VINCENNES IN
47591-0556
US

V. Phone/Fax

Practice location:
  • Phone: 812-885-2720
  • Fax: 812-885-2723
Mailing address:
  • Phone: 812-494-9501
  • Fax: 812-494-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003238A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: