1033490479 NPI number — DR. KARI LYNN NEUBAUER POTTHOFF PHD, LMFT

Table of content: DR. KARI LYNN NEUBAUER POTTHOFF PHD, LMFT (NPI 1033490479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033490479 NPI number — DR. KARI LYNN NEUBAUER POTTHOFF PHD, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEUBAUER POTTHOFF
Provider First Name:
KARI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POTTHOFF
Provider Other First Name:
KARI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD, LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033490479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
679 E NANCY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN TAN VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85140-4195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
679 E NANCY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN TAN VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85140-4195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-222-9960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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