Healthcare Provider Details

I. General information

NPI: 1073130530
Provider Name (Legal Business Name): HALEY POTTORFF KINNEY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N MARKET ST
MOUNT CARMEL IL
62863-1945
US

IV. Provider business mailing address

1001 N MARKET ST STE 101
MOUNT CARMEL IL
62863-1945
US

V. Phone/Fax

Practice location:
  • Phone: 618-599-6310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: