Provider Demographics
NPI:1467945055
Name:POTRATZ, TRISTIN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:TRISTIN
Middle Name:
Last Name:POTRATZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TRISTIN
Other - Middle Name:
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-9030
Mailing Address - Fax:515-643-9031
Practice Address - Street 1:6601 SW 9TH ST STE 2
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-6138
Practice Address - Country:US
Practice Address - Phone:515-643-9030
Practice Address - Fax:515-643-9031
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health