Provider Demographics
NPI:1285962472
Name:PORTERFIELD, KELLY DIANE (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DIANE
Last Name:PORTERFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DIANE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5265 N ACADEMY BLVD STE 1800
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4061
Mailing Address - Country:US
Mailing Address - Phone:719-648-0920
Mailing Address - Fax:719-635-9946
Practice Address - Street 1:5265 N ACADEMY BLVD STE 1800
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4061
Practice Address - Country:US
Practice Address - Phone:719-648-0920
Practice Address - Fax:719-635-9946
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-26
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO754938Medicaid