Provider Demographics
NPI:1447009188
Name:PORTER, MARK ELLIOTT II (LPCA, TCM)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ELLIOTT
Last Name:PORTER
Suffix:II
Gender:M
Credentials:LPCA, TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SILVERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2907
Mailing Address - Country:US
Mailing Address - Phone:859-358-7145
Mailing Address - Fax:
Practice Address - Street 1:236 W MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1876
Practice Address - Country:US
Practice Address - Phone:859-358-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY287878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health