Provider Demographics
NPI:1295790806
Name:POTTER, THOMAS W (LCSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:POTTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 NE D STREET
Mailing Address - Street 2:STE C
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462
Mailing Address - Country:US
Mailing Address - Phone:918-967-3368
Mailing Address - Fax:918-967-3351
Practice Address - Street 1:1407 NE D STREET
Practice Address - Street 2:STE C
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462
Practice Address - Country:US
Practice Address - Phone:918-967-3368
Practice Address - Fax:918-967-3351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker