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Individual

BETHANY PORTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
2161 OLD HIGHWAY 13, EQUALITY, IL 62934-2035
(618) 384-8055
Mailing address
2161 OLD HIGHWAY 13, EQUALITY, IL 62934-2035
(618) 384-8055

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
149023108
IL

Other

Enumeration date
04/08/2021
Last updated
12/28/2022
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