Provider Demographics
NPI:1558718411
Name:POTEET, ABBY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:POTEET
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:BOLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19135 HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-9301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19135 HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-9301
Practice Address - Country:US
Practice Address - Phone:479-238-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARP230617101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator