Individual
MS. THERESA ANN PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
600 SOUTH 2ND STREET, SUITE 201, BISMARCK, ND 58504-5729
(701) 258-3780
(701) 258-6431
Mailing address
600 SOUTH 2ND STREET, SUITE 201, BISMARCK, ND 58504-5729
(701) 258-3780
(701) 258-6431
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2020
ND
1041C0700X
Clinical Social Worker
2020
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19146
—
ND
01
—
26413
BCBS
ND
01
—
BCBS 26413
MSW,LICSW
ND
01
—
HP65337
HEALTH PARTNERS
—
05
—
PIN 19146
—
ND
Enumeration date
08/31/2006
Last updated
03/03/2010
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