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General NPI Number Information
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NPI Number | 1609302124
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Entity Type | Organization
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Legal Business Name | PORTER'S HOUSE FOR HEALING COMMUNITY COUNSELING SERVICES
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 2906 EDGEWICK ELM ST
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City | FRESNO
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State | TX
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Zip | 77545-8131
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Country | US
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Telephone | 713-315-0394
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Fax |
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Provider Business Mailing Address
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Address Line | 2906 EDGEWICK ELM ST
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City | FRESNO
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State | TX
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Zip | 77545-8131
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Country | US
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Telephone | 713-315-0394
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TERI LYNN ROBERTS
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Credential |
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Telephone | 713-315-0394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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