Provider Demographics
NPI:1396299384
Name:POTHIER, MAIA LAURA
Entity type:Individual
Prefix:
First Name:MAIA
Middle Name:LAURA
Last Name:POTHIER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAIA
Other - Middle Name:LAURA
Other - Last Name:POTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2801 S VALLEY VIEW BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0166
Mailing Address - Country:US
Mailing Address - Phone:702-922-7015
Mailing Address - Fax:
Practice Address - Street 1:2801 S VALLEY VIEW BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0166
Practice Address - Country:US
Practice Address - Phone:702-922-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1881842953Medicaid