Provider Demographics
NPI:1902925845
Name:POTTLE, HEIDI (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:POTTLE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7803 19TH LN SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3484
Mailing Address - Country:US
Mailing Address - Phone:360-280-8200
Mailing Address - Fax:
Practice Address - Street 1:7803 19TH LN SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3484
Practice Address - Country:US
Practice Address - Phone:360-280-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00057539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health