Provider Demographics
NPI:1386943280
Name:POTEET, EARL ROSS (LCSW)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:ROSS
Last Name:POTEET
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 FAIRWAY VLG
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-3621
Mailing Address - Country:US
Mailing Address - Phone:303-908-8623
Mailing Address - Fax:
Practice Address - Street 1:117 FAIRWAY VLG
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-3621
Practice Address - Country:US
Practice Address - Phone:303-908-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-18091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical