Individual
CHRISTIAN WAYNE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
322 DUPONT DR STE C, SEYMOUR, IN 47274-1764
(317) 334-7331
Mailing address
415 MEDICAL DR STE D101, BOUNTIFUL, UT 84010-8905
(801) 683-1062
(801) 295-5537
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-401227
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300033976
—
IN
Enumeration date
12/31/2019
Last updated
07/07/2020
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