Provider Demographics
NPI:1265736698
Name:POTTS, BRYANT LAMONT (INSTRUCTOR, EMT, RBT)
Entity type:Individual
Prefix:MR
First Name:BRYANT
Middle Name:LAMONT
Last Name:POTTS
Suffix:
Gender:M
Credentials:INSTRUCTOR, EMT, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S BROADWAY STE 310
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 S BROADWAY STE 310
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5218
Practice Address - Country:US
Practice Address - Phone:888-531-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No101Y00000XBehavioral Health & Social Service ProvidersCounselor