Provider Demographics
NPI:1699310888
Name:PORCH, HEATHER LAVELLE (BSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LAVELLE
Last Name:PORCH
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LAVELLE
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37875 JASPER LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:OR
Mailing Address - Zip Code:97438-9751
Mailing Address - Country:US
Mailing Address - Phone:541-747-1235
Mailing Address - Fax:541-747-4722
Practice Address - Street 1:37875 JASPER LOWELL RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:OR
Practice Address - Zip Code:97438-9751
Practice Address - Country:US
Practice Address - Phone:541-747-1235
Practice Address - Fax:541-747-4722
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health