Provider Demographics
NPI:1538177621
Name:PORTERFIELD, AVA LOUISE (LPC)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:LOUISE
Last Name:PORTERFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CHESTNUT STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602
Mailing Address - Country:US
Mailing Address - Phone:325-676-8963
Mailing Address - Fax:325-676-2915
Practice Address - Street 1:506 EAST 28TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-4029
Practice Address - Country:US
Practice Address - Phone:979-224-0832
Practice Address - Fax:979-450-7896
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14265101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84919LOtherBCBS OF TX