Provider Demographics
NPI:1487971016
Name:PORTER, BRITTANI AMBER MARIE (LPCC, LADC)
Entity type:Individual
Prefix:MRS
First Name:BRITTANI
Middle Name:AMBER MARIE
Last Name:PORTER
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5563 HUGO RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2344
Mailing Address - Country:US
Mailing Address - Phone:651-468-5036
Mailing Address - Fax:
Practice Address - Street 1:5563 HUGO RD
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-2344
Practice Address - Country:US
Practice Address - Phone:651-465-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300933101YA0400X
MNCC02078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)