Provider Demographics
NPI:1053778969
Name:PORTER, AARON (MS, LPC, LMFT, QMH)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:MS, LPC, LMFT, QMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 CENTENNIAL BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3378
Mailing Address - Country:US
Mailing Address - Phone:541-203-6698
Mailing Address - Fax:541-229-1285
Practice Address - Street 1:1717 CENTENNIAL BLVD STE 12
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3378
Practice Address - Country:US
Practice Address - Phone:541-203-6698
Practice Address - Fax:541-229-1285
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5488101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health