Provider Demographics
NPI:1881463016
Name:POTTER, LAURA (LCPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 N 15TH ST STE 150-04
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4327
Mailing Address - Country:US
Mailing Address - Phone:623-203-8674
Mailing Address - Fax:
Practice Address - Street 1:10229 N 12TH CT UNIT 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-1672
Practice Address - Country:US
Practice Address - Phone:623-203-8674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17760101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral