Provider Demographics
NPI:1891987012
Name:POTT, KENNETH JAMES (LPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JAMES
Last Name:POTT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 ZANG ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1739
Mailing Address - Country:US
Mailing Address - Phone:303-431-0763
Mailing Address - Fax:303-431-1880
Practice Address - Street 1:12600 W 32ND AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5253
Practice Address - Country:US
Practice Address - Phone:303-918-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4701101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional