Active NPI
Larry Porta LLC
- Mental Health Counselor
- Gaylord, MI
National Provider Identifier
1639729262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 006513220001 | Medicaid | MI |
Other names 1
- Larry Porta Counseling Services
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Gaylord |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Mental Health Counselor
- Gaylord, MI
- NPI 1982139580
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.