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General NPI Number Information
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NPI Number | 1467130518
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Entity Type | Individual
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Provider Name | KIMBERLY JO POTTER LPC
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Gender | Female
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 2931 HIGHWAY 260
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City | OVERGAARD
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State | AZ
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Zip | 85933
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Country | US
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Telephone | 928-892-5243
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Fax |
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Provider Business Mailing Address
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Address Line | 1024 PONDEROSA DR
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City | SHOW LOW
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State | AZ
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Zip | 85901-8260
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Country | US
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Telephone | 928-358-2504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-21329
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License Number State | AZ
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