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General NPI Number Information
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NPI Number | 1467103424
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Entity Type | Individual
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Provider Name | JANICE PORTER
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Gender | Female
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 5261 DELMAR BLVD STE 214
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1094
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Country | US
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Telephone | 314-449-1180
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Fax |
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Provider Business Mailing Address
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Address Line | 1492 SHERWOOD FOREST DR
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City | FLORISSANT
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State | MO
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Zip | 63031-1553
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Country | US
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Telephone | 314-604-7657
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | MO
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