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1114647328
LOGAN MITCHELL PORTER
LACEY, WA
NPI
1114647328
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101Y00000X Counselor
(Licence: WA 61310165)
Enumeration Date
2022-08-29
Last Update Date
2022-08-29
Business Address
LOGAN MITCHELL PORTER CL 61310165
4419 21ST CT SE
LACEY, WA 98503-7036
Phone number: 253-777-7269
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Mailing Address
LOGAN MITCHELL PORTER CL 61310165
4419 21ST CT SE
LACEY, WA 98503-7036
Phone number: 253-777-7269
Copy
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