Provider Demographics
NPI:1174025696
Name:POTTS, BRYANT L (MS)
Entity Type:Individual
Prefix:MR
First Name:BRYANT
Middle Name:L
Last Name:POTTS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 CROWS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-5622
Mailing Address - Country:US
Mailing Address - Phone:209-985-9844
Mailing Address - Fax:
Practice Address - Street 1:811 SAN RAMON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4025
Practice Address - Country:US
Practice Address - Phone:925-968-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst