Individual
LATISHA DENISE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
920 NW 109TH ST, OKLAHOMA CITY, OK 73114-6908
(405) 200-3582
Mailing address
920 NW 109TH ST, OKLAHOMA CITY, OK 73114-6908
(405) 200-3582
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
OK
101YM0800X
Mental Health Counselor
—
OK
101YP2500X
Professional Counselor
Primary
—
OK
Other
Enumeration date
07/08/2010
Last updated
07/08/2010
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