| Larry Porta Llc | |
|
440 W Main St Ste C Gaylord MI 49735-1885 | |
| (989) 448-2640 | |
| (989) 448-2639 |
| Full Name | Larry Porta Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 440 W Main St Ste C, Gaylord, Michigan |
| Authorized Official Name and Position | Larry Porta (OWNER) |
| Authorized Official Contact | 9894482640 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larry Porta Llc 440 W Main St Ste C Gaylord MI 49735-1885 Ph: (989) 448-2640 | Larry Porta Llc 440 W Main St Ste C Gaylord MI 49735-1885 Ph: (989) 448-2640 |
| NPI Number | 1639729262 |
|---|---|
| Provider Enumeration Date | 09/16/2019 |
| Last Update Date | 09/16/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639729262 | NPI | - | NPPES |
| 006513220001 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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