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Individual
JESSE PORTILLO
Active
Individual
JESSE PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
20463-130
WI
101YP2500X
Professional Counselor
Primary
11211-125
WI
Other
Enumeration date
07/15/2022
Last updated
07/29/2024
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