Provider Demographics
NPI:1639624935
Name:POTEET, LORRIE (PHD,)
Entity Type:Individual
Prefix:DR
First Name:LORRIE
Middle Name:
Last Name:POTEET
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 HAYFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-5098
Mailing Address - Country:US
Mailing Address - Phone:307-760-2132
Mailing Address - Fax:
Practice Address - Street 1:3517 HAYFORD AVE
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-5098
Practice Address - Country:US
Practice Address - Phone:307-755-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1597101YP2500X
MOPY01580103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling