MEDICARE: RICHARD W POTTS PHD

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
1	103T00000X	Psychologist	321543-2501	UT

General Provider Information

NPI Number	:	1689695116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD W POTTS PHD

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-357-7525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1157 N 300 W
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6124
Country	:	US
Telephone Number	:	801-357-7525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	01/26/2016

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