Provider Demographics
NPI:1497133599
Name:POTOCKI, SHELLEE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEE
Middle Name:
Last Name:POTOCKI
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 1:504 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1408
Mailing Address - Country:US
Mailing Address - Phone:425-407-2258
Mailing Address - Fax:425-512-0910
Practice Address - Street 1:8490 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-3206
Practice Address - Country:US
Practice Address - Phone:425-407-2258
Practice Address - Fax:425-512-0910
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60547365101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor