Individual
MR. PHIL T PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Contact information
Practice address
1229 C AVE E, #300, OSKALOOSA, IA 52577-4246
(641) 672-3159
(641) 672-3259
Mailing address
1229 C AVENUE EAST, #300, OSKALOOSA, IA 52577
(641) 672-3159
(641) 672-3259
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
00095
IA
Other
Enumeration date
07/26/2006
Last updated
07/08/2007
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