Provider Demographics
NPI:1427226505
Name:POTTER, KARIN DELIA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:DELIA
Last Name:POTTER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 N STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5232
Mailing Address - Country:US
Mailing Address - Phone:406-855-8261
Mailing Address - Fax:509-744-3055
Practice Address - Street 1:1312 N MONROE ST STE 139
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2623
Practice Address - Country:US
Practice Address - Phone:406-855-8261
Practice Address - Fax:509-744-3055
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60205579101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2182486Medicaid