Provider Demographics
NPI:1982760070
Name:POTTER, THOMAS WL (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WL
Last Name:POTTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 N E ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-1760
Mailing Address - Country:US
Mailing Address - Phone:503-884-3464
Mailing Address - Fax:
Practice Address - Street 1:201 TRUEBLOOD AVE
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-1757
Practice Address - Country:US
Practice Address - Phone:641-673-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health