Provider Demographics
NPI:1609188226
Name:POTTER, LISA ELAINE (LSCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELAINE
Last Name:POTTER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELAINE
Other - Last Name:PARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:200 MAINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1390
Mailing Address - Country:US
Mailing Address - Phone:785-843-9192
Mailing Address - Fax:
Practice Address - Street 1:200 MAINE ST STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1390
Practice Address - Country:US
Practice Address - Phone:785-843-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical