JEFFERY PORTER

POCATELLO, ID
NPI1568823060
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: ID  LMSW-34705)
Enumeration Date2016-03-10
Last Update Date2016-03-10
Business Address
Mr. JEFFERY PORTER
151 N 3RD AVE STE 404
POCATELLO, ID 83201-6331
Phone number: 208-478-9822
Mailing Address
Mr. JEFFERY PORTER
3079 SANDY DR
IDAHO FALLS, ID 83401-6050
Phone number: 801-842-4987
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