Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 2015033025 | MO |
Y | 102L00000X | Psychologist | P0000003473 | TN |
Y | 103T00000X | Psychologist | P0000003473 | TN |
NPI | 1013387687 |
---|---|
Provider Name | Dr. Nicholas Porta |
First Address | Johnson City, TN 37601-1754 |
Second Address | Johnson City, TN 37601-1754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2015 |
Last Update Date | 21/03/2018 |