Individual
LAURA GUSTAFSON PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
7714 CONNER RD STE 105, POWELL, TN 37849-3559
(865) 947-6220
(865) 512-1069
Mailing address
6350 W ANDREW JOHNSON HWY DEPT 100, TALBOTT, TN 37877-8605
(800) 355-3565
(423) 714-2355
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
2546(PROVISIONAL)
TN
103TC0700X
Clinical Psychologist
Primary
P2546
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3981441
—
TN
Enumeration date
07/19/2005
Last updated
11/30/2017
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