Doctor Name: | MR. NATHAN R PORTER |
NPI Number: | 1003952912 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | LCSW-27844 |
Business Practice Address: | 2060 E 25th St Idaho Falls, ID - 834046490 |
Business Phone Number: | 2083462363 |
Business Fax Number: | 2085245725 |
Mailing Address: | 3749 S 5th W, IDAHO FALLS |
State: | ID |
Postal Code: | 834047916 |
Phone Number: | 2083462363 |
Fax Number: | 2085245725 |
NPI Enumeration Date: | 01/29/2007 |
NPI Last Update Date: | 08/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCSW-27844 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |