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General NPI Number Information
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NPI Number | 1235837709
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Entity Type | Organization
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Legal Business Name | ISSAURA POTTER, LLC
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 175 E 50TH ST
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City | GARDEN CITY
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State | ID
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Zip | 83714-1413
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Country | US
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Telephone | 208-204-0451
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Fax |
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Provider Business Mailing Address
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Address Line | 2268 S ELDERBERRY PL
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City | BOISE
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State | ID
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Zip | 83706-4492
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | ISSA POTTER
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Credential | LPC
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Telephone | 208-519-0901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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