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NPI Code Detail

MEDICARE: CINDI MICHELE PORTER AAC

MEDICARE: CINDI MICHELE PORTER AAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YM0800XMental Health CounselorCG60806049WA

General Provider Information

NPI Number : 1134784143
Entity Type Code : Individual
Provider Name (Legal Business Name) : CINDI MICHELE PORTER AAC
Provider Business Mailing Address
First Line : COMPREHENSIVE LIFE RESOURCES
Second Line : 1305 TACOMA AVENUE SOUTH
City : TACOMA
State : WA
Zip : 98402-1903
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2428 W REYNOLDS AVE
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-4554
Country : US
Telephone Number : 360-623-8020
Fax Number : 360-623-1084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2019
Last Update Date : 12/12/2019

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Directions to “ CINDI MICHELE PORTER AAC” Practice Location

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