Individual
SHANNEY SHONTTILE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4011 W SURREY AVE, PHOENIX, AZ 85029-1949
(602) 298-6987
Mailing address
4011 W SURREY AVE, PHOENIX, AZ 85029-1949
(602) 298-6987
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
209618
AZ
Other
Enumeration date
08/28/2007
Last updated
08/28/2007
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