Basic Information
| Provider Information | |||||||||
| NPI: | 1891898730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | M.DIV | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 ARMSTRONG ROAD | ||||||||
| Address2: | BATTLE CREEK VAMC CHAPLAIN SECTION (012C) | ||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699665600 | ||||||||
| FaxNumber: | 2696605008 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 ARMSTRONG ROAD | ||||||||
| Address2: | BATTLE CREEK VAMC | ||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699665600 | ||||||||
| FaxNumber: | 2696605008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP1600X | Y | Behavioral Health & Social Service Providers | Counselor | Pastoral |
No ID Information.