Provider Demographics
NPI:1124882360
Name:POTTKOTTER, HALEY
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:
Last Name:POTTKOTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EAGLE DR STE A
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-9714
Mailing Address - Country:US
Mailing Address - Phone:419-628-6156
Mailing Address - Fax:
Practice Address - Street 1:4 EAGLE DR STE A
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-9714
Practice Address - Country:US
Practice Address - Phone:419-628-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.2400304106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist