Healthcare Provider Details

I. General information

NPI: 1093645236
Provider Name (Legal Business Name): ZOLIE M POTTER LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17547 W BUCHANAN ST
GOODYEAR AZ
85338-2575
US

IV. Provider business mailing address

17547 W BUCHANAN ST
GOODYEAR AZ
85338-2575
US

V. Phone/Fax

Practice location:
  • Phone: 253-257-5177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMC61560069
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: