Individual
MR. MICHAEL EDGAR PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
57 SOUTH MAIN, LOA, UT 84747
(435) 624-3304
Mailing address
PO BOX 120045, ANTIMONY, UT 84712-0045
(435) 624-3304
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6890665-6006
UT
Other
Enumeration date
02/19/2013
Last updated
02/19/2013
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