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Individual

CHAD MICHAEL PORTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
855 N CAPITAL AVE STE 1, IDAHO FALLS, ID 83402-3405
(208) 552-0855
Mailing address
855 N CAPITAL AVE STE 1, IDAHO FALLS, ID 83402-3405
(208) 552-0855

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW33747
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1881708832
ID
Enumeration date
06/04/2010
Last updated
01/17/2025
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