MEDICARE: RITA MARIE PORTER LCPC

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
1	101YM0800X	Mental Health Counselor	3887-125	WI
2	101YM0800X	Mental Health Counselor	180-002881	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144423906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA MARIE PORTER LCPC

Provider Business Mailing Address
First Line	:	2671 STONE CIR
Second Line	:	#205
City	:	GENEVA
State	:	IL
Zip	:	60134-1008
Country	:	US
Telephone Number	:	630-966-4329
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 N HIGHLAND AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-1401
Country	:	US
Telephone Number	:	630-966-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	05/03/2012

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Directions to “ RITA MARIE PORTER LCPC” Practice Location

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