Organization Active NPI

Larry Porta LLC

  • Mental Health Counselor
  • Gaylord, MI
National Provider Identifier
1639729262
Registry record updated Sep 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
LARRY PORTA LLC
Practice address
440 W Main St Ste C
Gaylord, MI 49735-1885
Phone
(989) 448-2640
Fax
(989) 448-2639
NPI assigned
Sep 16, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2019

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

Authorized official

Name
Larry Porta, LPC
Title
Owner
Phone
(989) 448-2640

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

440 W Main St Ste C
Gaylord, MI 49735-1885

Mailing address

440 W Main St Ste C
Gaylord, MI 49735-1885
Phone (989) 448-2640

Other identifiers 1

IdentifierTypeStateIssuer
006513220001MedicaidMI

Other names 1

  • Larry Porta Counseling Services Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Gaylord

National Provider Directory

National Provider Directory

Locations

440 W Main St
Ste C
Gaylord, MI 49735
Phone (231) 420-0461

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568592000000",
    "number": "1639729262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 W MAIN ST STE C",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351885",
            "telephone_number": "989-448-2640",
            "fax_number": "989-448-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 W MAIN ST STE C",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351885",
            "telephone_number": "989-448-2640",
            "fax_number": "989-448-2639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY PORTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-16",
        "last_updated": "2019-09-16",
        "status": "A",
        "authorized_official_last_name": "PORTA",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-448-2640",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006513220001",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Gaylord",
            "affiliation": "N",
            "address_1": "440 W Main St Ste C",
            "city": "Gaylord",
            "state": "MI",
            "country_code": "US",
            "postal_code": "497351885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Larry Porta Counseling Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaylord, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.