Provider Demographics
NPI:1548490535
Name:MECHLEY-PORTER, PENELOPE MARIE (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:MARIE
Last Name:MECHLEY-PORTER
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:MECHLEY
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3910 CAUGHEY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4097
Mailing Address - Country:US
Mailing Address - Phone:814-746-3910
Mailing Address - Fax:814-746-3912
Practice Address - Street 1:3910 CAUGHEY RD STE 120
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4097
Practice Address - Country:US
Practice Address - Phone:814-746-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional