Travis Porter, PSY, LAC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY.0003920 Issued in CO

Practice address

1795 Jet Wing Dr
Colorado Springs, CO 80916

Phone

(719) 572-6100

Fax

(719) 572-6089

NPI assigned

Feb 13, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Diversus Health Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Colorado Springs, CO
  • NPI 1043260243
  Medicare reassignment

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533686400000",
    "number": "1396887451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 RUSKIN DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80910",
            "telephone_number": "719-572-6100",
            "fax_number": "719-572-6080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1795 JET WING DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80916",
            "telephone_number": "719-572-6100",
            "fax_number": "719-572-6089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "TRAVIS",
        "credential": "PSY, LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2018-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "PSY.0003920",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "203",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Porter, OTR/L
• Michah Porter
• Nicole Porter
• Stephanie Porter, LMHC, LPC
• Stephanie A Porter, RN, MSN
• Tyree Porter
• Zachary Millslagle Porter, MPH, CSCS
• Portercare Adventist Health System
• Portercare Adventist Health System
• Kelly Diane Porterfield, LPC

• Clinical Psychologist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.