Healthcare Provider Details

I. General information

NPI: 1659639177
Provider Name (Legal Business Name): KERRY POTTS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 07/24/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 PARKER ST
MAYNARD MA
01754-2178
US

IV. Provider business mailing address

534 UNIVERSITY PARK WAY
EAST WENATCHEE WA
98802
US

V. Phone/Fax

Practice location:
  • Phone: 866-991-2103
  • Fax:
Mailing address:
  • Phone: 509-669-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61138406
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: