Provider Demographics
NPI:1134243710
Name:POTAS, ANGELA LYNN (MA, LADC, LAMFT)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LYNN
Last Name:POTAS
Suffix:
Gender:F
Credentials:MA, LADC, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 W EAGLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-6149
Mailing Address - Country:US
Mailing Address - Phone:612-870-2410
Mailing Address - Fax:612-870-2403
Practice Address - Street 1:4432 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3519
Practice Address - Country:US
Practice Address - Phone:612-870-2410
Practice Address - Fax:612-870-2403
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1653106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist