Provider Demographics
NPI:1861744096
Name:POTTS, CHALESE MARIE
Entity type:Individual
Prefix:
First Name:CHALESE
Middle Name:MARIE
Last Name:POTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 S TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0649
Mailing Address - Country:US
Mailing Address - Phone:702-530-6265
Mailing Address - Fax:702-889-4406
Practice Address - Street 1:2980 S RAINBOW BLVD
Practice Address - Street 2:STE. 200 E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6531
Practice Address - Country:US
Practice Address - Phone:702-219-8788
Practice Address - Fax:702-889-4406
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor