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NPI Code Detail

MEDICARE: KATIE PORTILLO LPC

MEDICARE: KATIE PORTILLO LPC
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
1101YM0800XMental Health CounselorLPC014054GA

General Provider Information

NPI Number : 1407427016
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE PORTILLO LPC
Provider Business Mailing Address
First Line : 80 JESSE HILL JR DR SE
Second Line :
City : ATLANTA
State : GA
Zip : 30303-3031
Country : US
Telephone Number : 404-482-1516
Fax Number :
Provider Business Practice Location Address
First Line : 80 JESSE HILL JR DR SE
Second Line :
City : ATLANTA
State : GA
Zip : 30303-3031
Country : US
Telephone Number : 404-482-1516
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2021
Last Update Date : 01/05/2026

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Directions to “ KATIE PORTILLO LPC” Practice Location

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