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Larry Porta Llc
Mental Health Counselor in Gaylord, Michigan
NPI 1639729262

Larry Porta Llc is a Mental Health Counselor based in Gaylord, MI and is specialized in Mental Health. Larry Porta Llc practices in Gaylord, MI. The NPI Number for Larry Porta Llc is 1639729262 and holds a License No. (Michigan).

The current practice location address for Larry Porta Llc is 440 W Main St Ste C, Gaylord, MI and can be reached out via phone at 989-448-2640 and via fax at 989-448-2639.

Location: 440 W Main St Ste C, Gaylord, MI, 49735-1885
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1639729262
Provider Name
Larry Porta Llc
Credential
Provider Entity Type
Organization
Address
440 W Main St Ste C, Gaylord, MI, 49735-1885
Phone Number
989-448-2640
Fax Number
989-448-2639
Provider Enumeration Date
09/16/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
006513220001 05 MI
institution
Provider Business Practice Location Address Details
Address
440 W Main St Ste C
City
Gaylord
State
Michigan
Zip
49735-1885
Phone Number
989-448-2640
Fax Number
989-448-2639
person
Provider Business Mailing Address Details
Address
440 W Main St Ste C
City
Gaylord
State
Michigan
Zip
49735-1885
Phone Number
989-448-2640
Fax Number
989-448-2639
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
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