Provider Demographics
NPI:1013146687
Name:POTTS, LISA ANN (MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:POTTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 LINN STATION RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3842
Mailing Address - Country:US
Mailing Address - Phone:502-589-8600
Mailing Address - Fax:
Practice Address - Street 1:130 JOE B. HALL AVENUE
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-0690
Practice Address - Country:US
Practice Address - Phone:502-543-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-04
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105153106H00000X
KY100343103T00000X
KY163261106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist