Provider Demographics
NPI:1124853155
Name:PORTER, MOSADI (EDD)
Entity type:Individual
Prefix:MS
First Name:MOSADI
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29714 BUFFALO CANYON DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3454
Mailing Address - Country:US
Mailing Address - Phone:713-304-0417
Mailing Address - Fax:
Practice Address - Street 1:29714 BUFFALO CANYON DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-3454
Practice Address - Country:US
Practice Address - Phone:713-304-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional