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General NPI Number Information
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NPI Number | 1528971488
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Entity Type | Individual
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Provider Name | KEVIN POTTER LASAC
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Gender | Male
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 1204 E BASELINE RD STE 208
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City | TEMPE
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State | AZ
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Zip | 85283-1453
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Country | US
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Telephone | 480-209-1977
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Fax |
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Provider Business Mailing Address
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Address Line | 6504 S FOREST CT
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City | GILBERT
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State | AZ
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Zip | 85298-4890
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Country | US
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Telephone | 646-805-8168
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LAAC-15572
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License Number State | AZ
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