Provider Demographics
NPI:1053856765
Name:POTIER, MILES
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:POTIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 W SHILO AVE
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4050
Mailing Address - Country:US
Mailing Address - Phone:225-202-0304
Mailing Address - Fax:
Practice Address - Street 1:5105 W SHILO AVE
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4050
Practice Address - Country:US
Practice Address - Phone:225-202-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00000Medicaid