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General NPI Number Information
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NPI Number | 1588446470
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Entity Type | Individual
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Provider Name | RYAN THOMAS PORTER LMSW
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Gender | Male
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 263 INDUSTRIAL DR
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City | HILLSDALE
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State | MI
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Zip | 49242-1078
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Country | US
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Telephone | 517-826-5242
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Fax |
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Provider Business Mailing Address
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Address Line | 29190 ALBION RD
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City | ALBION
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State | MI
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Zip | 49224-9736
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Country | US
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Telephone | 313-451-7225
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801106935
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801106935
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License Number State | MI
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