Active NPI
Lisa Staires Pottorf, M.ED., LPC
- Mental Health Counselor
- Tulsa, OK
National Provider Identifier
1205031002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2224
- Practice address
- 4528 S Sheridan Rd Ste 117
Tulsa, OK 74145-1101 - Phone
- (918) 794-6570
- Fax
- (918) 340-5189
- NPI assigned
- Jun 20, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2224 | OK | Primary |
Addresses
Primary practice location
4528 S Sheridan Rd Ste 117
Tulsa, OK 74145-1101
Mailing address
4525 S. Irvington Ave.
Tulsa, OK 74135
Phone (918) 832-7764
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2224 | OK | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Betty Jackson Counseling Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Professional Counselor
- Tulsa, OK
- NPI 1508178070
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341273600000",
"number": "1205031002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4525 S. IRVINGTON AVE.",
"city": "TULSA",
"state": "OK",
"postal_code": "74135",
"telephone_number": "918-832-7764",
"fax_number": "918-832-7765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4528 S SHERIDAN RD STE 117",
"city": "TULSA",
"state": "OK",
"postal_code": "741451101",
"telephone_number": "918-794-6570",
"fax_number": "918-340-5189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTORF",
"first_name": "LISA",
"middle_name": "STAIRES",
"credential": "M.ED., LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-20",
"last_updated": "2012-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OK",
"license": "2224",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.