Individual
TRAVIS PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY, LAC
Contact information
Practice address
1795 JET WING DR, COLORADO SPRINGS, CO 80916
(719) 572-6100
(719) 572-6089
Mailing address
220 RUSKIN DR, COLORADO SPRINGS, CO 80910
(719) 572-6100
(719) 572-6080
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
203
CO
103TC0700X
Clinical Psychologist
Primary
PSY.0003920
CO
Other
Enumeration date
02/13/2007
Last updated
08/08/2018
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