Provider Demographics
NPI:1487927521
Name:PORTER, LEAH SHEARER (MS, MA, MFT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:SHEARER
Last Name:PORTER
Suffix:
Gender:F
Credentials:MS, MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 AVIATION BLVD # 118
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2805
Mailing Address - Country:US
Mailing Address - Phone:844-437-4737
Mailing Address - Fax:
Practice Address - Street 1:1119 1/2 S HOPE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2118
Practice Address - Country:US
Practice Address - Phone:213-749-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107808106H00000X
CA84087101YM0800X, 101YP2500X, 106H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator