Individual provider Active NPI

Nicole Porter, LCSW

  • Clinical Social Worker
  • Richardson, TX
National Provider Identifier
1053957092
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
53658 Issued in TX
Practice address
600 W Campbell Rd Ste 1
Richardson, TX 75080-3357
Phone
(847) 903-5604
Fax
(224) 788-5112
NPI assigned
Nov 25, 2019
Last updated
Nov 25, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 53658 TX Primary

Addresses

Primary practice location

600 W Campbell Rd Ste 1
Richardson, TX 75080-3357

Mailing address

PO Box 856
Antioch, IL 60002-0856
Phone (847) 903-5604

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191212002263 TX Practitioner - Clinical Social Worker 5597198184 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

Tomball, TX 77375
Phone (281) 826-2885

27708 Tomball Pkwy
Suite 1014
Tomball, TX 77375-6472

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Che Behavioral Health Counseling Services of Texas, P.a. Clinical CurrentSince Apr 12, 2022 Accepting new patients
Deer Oaks Geriatric Services P C CurrentSince Feb 3, 2020 Accepting new patients
Sondermind Provider Network LLC Clinical CurrentSince May 3, 2021 Accepting new patients

Locations

2000 E Lamar Blvd
Ste 600
Arlington, TX 76006
Phone (214) 519-9473

2021 Guadalupe St
Ste 260
Austin, TX 78705
Phone (202) 932-9958

7272 Wurzbach Rd
Ste 706
San Antonio, TX 78240
Phone (210) 615-3401

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1053957092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 856",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600020856",
            "telephone_number": "847-903-5604",
            "fax_number": "224-788-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W CAMPBELL RD STE 1",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750803357",
            "telephone_number": "847-903-5604",
            "fax_number": "224-788-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-25",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "53658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richardson, TX

Sources for this page

Verify at the official NPI Registry.