Provider Demographics
NPI:1063981777
Name:PORTERFIELD, SAMUEL RAY (LCSW)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:RAY
Last Name:PORTERFIELD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PFC FLOYD K. LINDSTROM OUTPATIENT CLINIC
Mailing Address - Street 2:3141 CENTENNIAL BLVD.
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-327-5660
Mailing Address - Fax:
Practice Address - Street 1:PFC FLOYD K. LINDSTROM OUTPATIENT CLINIC
Practice Address - Street 2:3141 CENTENNIAL BLVD.
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-327-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW141611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical