Individual
LISA STAIRES POTTORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., LPC
Contact information
Practice address
4528 S SHERIDAN RD STE 117, TULSA, OK 74145-1101
(918) 794-6570
(918) 340-5189
Mailing address
4525 S. IRVINGTON AVE., TULSA, OK 74135
(918) 832-7764
(918) 832-7765
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2224
OK
Other
Enumeration date
06/20/2007
Last updated
07/03/2012
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