Provider Demographics
NPI:1083749832
Name:POTTS, CASSANDRA LEE (MA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:POTTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:LEE
Other - Last Name:TRAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33238 COUNTY RD W
Mailing Address - Street 2:
Mailing Address - City:HILLROSE
Mailing Address - State:CO
Mailing Address - Zip Code:80733-9647
Mailing Address - Country:US
Mailing Address - Phone:970-370-4948
Mailing Address - Fax:
Practice Address - Street 1:418 ENSIGN ST
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2312
Practice Address - Country:US
Practice Address - Phone:970-370-4948
Practice Address - Fax:970-370-4948
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional