Provider Demographics
NPI:1902621683
Name:PORTER, MCKINZEY T H (PHD)
Entity type:Individual
Prefix:
First Name:MCKINZEY
Middle Name:T H
Last Name:PORTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 UNIVERSITY AVE APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3190
Mailing Address - Country:US
Mailing Address - Phone:808-392-7721
Mailing Address - Fax:
Practice Address - Street 1:752 UNIVERSITY AVE APT A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3190
Practice Address - Country:US
Practice Address - Phone:808-372-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2217103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist