Provider Demographics
NPI:1063892578
Name:PORTILLO, MARIA D (BA/AAC)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:D
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:BA/AAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 TIETON DRIVE, SUITE C
Mailing Address - Street 2:C/O CATHOLIC FAMILY &CHILD SERVICE
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3478
Mailing Address - Country:US
Mailing Address - Phone:509-965-7100
Mailing Address - Fax:509-966-9750
Practice Address - Street 1:5301 TIETON DRIVE, SUITE C
Practice Address - Street 2:C/O CATHOLIC FAMILY &CHILD SERVICE
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3478
Practice Address - Country:US
Practice Address - Phone:509-965-7100
Practice Address - Fax:509-966-9750
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60498310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health