Individual
JASON MICHAEL PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
10748 40TH ST N, LAKE ELMO, MN 55042-2225
(971) 666-9193
Mailing address
10748 40TH ST N, LAKE ELMO, MN 55042-2225
(971) 666-9193
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC02451
MN
Other
Enumeration date
04/27/2020
Last updated
01/25/2024
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