Healthcare Provider Details

I. General information

NPI: 1871489906
Provider Name (Legal Business Name): LE ANN PORTER LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S MAUMEE ST
TECUMSEH MI
49286-2033
US

IV. Provider business mailing address

164 SAND CREEK HWY APT K
ADRIAN MI
49221-9182
US

V. Phone/Fax

Practice location:
  • Phone: 517-423-6889
  • Fax: 517-423-6890
Mailing address:
  • Phone: 517-918-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024336
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: