Healthcare Provider Details

I. General information

NPI: 1407779648
Provider Name (Legal Business Name): STEPHANIE M PORTER LPC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N MAIN ST UNIT A
SPRINGBORO OH
45066-7520
US

IV. Provider business mailing address

509 N CLARIDGE DR
KETTERING OH
45429-1553
US

V. Phone/Fax

Practice location:
  • Phone: 937-741-8708
  • Fax: 937-550-4619
Mailing address:
  • Phone: 937-741-8708
  • Fax: 937-550-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.2607999-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: