Individual
MOLLY PORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1930 MESQUITE AVE, SUITE # 1A, LAKE HAVASU CITY, AZ 86403
(928) 855-4900
(928) 855-4902
Mailing address
1930 MESQUITE AVE, SUITE # 1A, LAKE HAVASU CITY, AZ 86403
(928) 855-4900
(928) 855-4902
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-16468
AZ
Other
Enumeration date
06/06/2014
Last updated
08/30/2019
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