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General NPI Number Information
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NPI Number | 1326587098
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Entity Type | Individual
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Provider Name | JENNIFER JO PORTER M.A.,LPC
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Gender | Female
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 11/06/2021
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Provider Practice Location Address
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Address Line | 1506 N GREENVILLE AVE STE 200
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City | ALLEN
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State | TX
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Zip | 75002-8693
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Country | US
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Telephone | 214-509-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 111 2ND ST
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City | JONESBURG
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State | MO
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Zip | 63351-1301
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Country | US
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Telephone | 573-777-2812
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 75143
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License Number State | TX
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