Provider Demographics
NPI:1245375609
Name:CYNTHIA DENISE PORTER DBA OVER THE RAINBOW PSYCHOTHERAPY
Entity type:Organization
Organization Name:CYNTHIA DENISE PORTER DBA OVER THE RAINBOW PSYCHOTHERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:POETER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:956-928-1749
Mailing Address - Street 1:6101 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4746
Mailing Address - Country:US
Mailing Address - Phone:956-928-1749
Mailing Address - Fax:956-928-0095
Practice Address - Street 1:4313 N 10TH ST STE F
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3065
Practice Address - Country:US
Practice Address - Phone:956-928-1749
Practice Address - Fax:956-928-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14112101YP2500X
TX169881041C0700X
TX158011041C0700X
TX402161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120744OtherCHIP
TX120744OtherCHIP