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MR. LANE CANNON PORTER CMHC

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1346540085

Individual Registrant:
MR. LANE CANNON PORTER CMHC
Gender: M
Not Sole Proprietor

Location and contact information for practice:
2973 W 13800 S  BLUFFDALE, UT 84065-8202 US
Tel: 801-577-4804  Fax: 844-965-9279

Contact information for business:
473 E CAROLINE DAY CV  DRAPER, UT 84020-5164 US
Tel: 801-577-4804  Fax: --

Registration Information:
NPI: 1346540085
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
UT7960484-6004

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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