Provider Demographics
NPI:1700968328
Name:POTTS, RONNIE (MFT-I)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:
Last Name:POTTS
Suffix:
Gender:M
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 COHASSET RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2290
Mailing Address - Country:US
Mailing Address - Phone:530-879-5050
Mailing Address - Fax:
Practice Address - Street 1:254 COHASSET RD STE 30
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2290
Practice Address - Country:US
Practice Address - Phone:530-879-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 58907106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XOtherMARRIAGE FAMILY THERAPIST
CA167G00000XOtherLICENSED PSYCHIATRIC TECH