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NPI Code Detail

MEDICARE: MRS. SHELLEE POTOCKI MA, LMHC

MEDICARE: MRS. SHELLEE POTOCKI MA, LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorLH60547365WA

General Provider Information

NPI Number : 1497133599
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHELLEE POTOCKI MA, LMHC
Provider Business Mailing Address
First Line : 504 19TH ST
Second Line :
City : SNOHOMISH
State : WA
Zip : 98290-1408
Country : US
Telephone Number : 425-407-2258
Fax Number : 425-512-0910
Provider Business Practice Location Address
First Line : 8490 MUKILTEO SPEEDWAY
Second Line : SUITE 202
City : MUKILTEO
State : WA
Zip : 98275-3206
Country : US
Telephone Number : 425-407-2258
Fax Number : 425-512-0910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2015
Last Update Date : 05/11/2015

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