MEDICARE: MRS. KATIE NICOLE POTTS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	132822	CA

General Provider Information

NPI Number	:	1093255374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATIE NICOLE POTTS LMFT

Provider Business Mailing Address
First Line	:	1680 W SHAW AVE STE 100
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3504
Country	:	US
Telephone Number	:	209-465-1080
Fax Number	:	209-465-2709

Provider Business Practice Location Address
First Line	:	1680 W SHAW AVE STE 100
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3504
Country	:	US
Telephone Number	:	209-465-1080
Fax Number	:	209-465-2709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	10/02/2025

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