Provider Demographics
NPI:1972774602
Name:PORTO UNIAO, INC
Entity type:Organization
Organization Name:PORTO UNIAO, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVERL
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-676-0926
Mailing Address - Street 1:212 W IRONWOOD DR STE D311
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-1403
Mailing Address - Country:US
Mailing Address - Phone:208-676-0926
Mailing Address - Fax:208-772-5969
Practice Address - Street 1:2180 W IRONWOOD CENTER DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2639
Practice Address - Country:US
Practice Address - Phone:208-676-0926
Practice Address - Fax:208-772-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID202060251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health