MEDICARE: DR. DANIEL B. PORTER PH.D.

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	101YP2500X	Professional Counselor	0701000644	VA

General Provider Information

NPI Number	:	1740361732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL B. PORTER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 20071
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-0008
Country	:	US
Telephone Number	:	540-989-5640
Fax Number	:	540-989-6587

Provider Business Practice Location Address
First Line	:	4248 OLD CAVE SPRING RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3417
Country	:	US
Telephone Number	:	540-989-5640
Fax Number	:	540-989-6587

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/09/2007

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