Provider Demographics
NPI:1225897259
Name:POTTS, LOGAN B (MS , BCBA)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:B
Last Name:POTTS
Suffix:
Gender:M
Credentials:MS , BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N ARIZONA AVE APT 1026
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1249
Mailing Address - Country:US
Mailing Address - Phone:602-552-9644
Mailing Address - Fax:
Practice Address - Street 1:2730 S VAL VISTA DR
Practice Address - Street 2:BILDG 4 SUITE 117
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295
Practice Address - Country:US
Practice Address - Phone:480-608-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-24-71571103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst