Individual
JESSE PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1191 HUNTINGTON AVE, WISCONSIN RAPIDS, WI 54494-6364
(715) 818-6465
Mailing address
1191 HUNTINGTON AVE, WISCONSIN RAPIDS, WI 54494-6364
(715) 213-3570
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
20463-130
WI
101YP2500X
Professional Counselor
Primary
11211-125
WI
Other
Enumeration date
07/15/2022
Last updated
07/29/2024
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