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General NPI Number Information
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NPI Number | 1710057724
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Entity Type | Individual
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Provider Name | MARY LYNN PORTER LCSW, LPC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 101 SOUTHWESTERN BOULEVARD SUITE 113
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City | SUGAR LAND
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State | TX
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Zip | 77478
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Country | US
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Telephone | 713-306-2738
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Fax | 281-242-0111
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Provider Business Mailing Address
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Address Line | P.O. BOX 10803
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City | HOUSTON
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State | TX
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Zip | 77206
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Country | US
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Telephone | 713-306-2738
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Fax | 281-242-0111
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 06462
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 000871
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 002372
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License Number State | TX
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