Doctor Name: | TRAVIS PORTER |
NPI Number: | 1396887451 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSYD, LAC |
License Number: | |
Business Practice Address: | 875 West Moreno Ave Colorado Springs, CO - 80905 |
Business Phone Number: | 7195726200 |
Business Fax Number: | 7195726299 |
Mailing Address: | 220 Ruskin Dr, COLORADO SPRINGS |
State: | CO |
Postal Code: | 80910 |
Phone Number: | 7195726100 |
Fax Number: | 7195726080 |
NPI Enumeration Date: | 02/13/2007 |
NPI Last Update Date: | 11/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |