Individual
ISSAURA MARIBEL POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
6003 W OVERLAND RD STE 101, BOISE, ID 83709-3075
(208) 204-0451
Mailing address
2268 S ELDERBERRY PL, BOISE, ID 83706-4492
(208) 519-0901
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
8841
ID
101YP2500X
Professional Counselor
Primary
8841
ID
Other
Enumeration date
06/10/2022
Last updated
06/13/2022
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