Basic Information
| Provider Information | |||||||||
| NPI: | 1912330846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | ASHTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 S DE LACEY AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263957100 | ||||||||
| FaxNumber: | 6263957270 | ||||||||
| Practice Location | |||||||||
| Address1: | 12450 VAN NUYS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913311392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188968366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2013 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.