Provider Demographics
NPI:1073767554
Name:POTTS, SUSAN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:POTTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23177 LA CADENA DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1428
Mailing Address - Country:US
Mailing Address - Phone:949-859-4414
Mailing Address - Fax:949-455-9822
Practice Address - Street 1:23177 LA CADENA DR STE 103
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1428
Practice Address - Country:US
Practice Address - Phone:949-859-4414
Practice Address - Fax:949-455-9822
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8657103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist