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General NPI Number Information
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NPI Number | 1023470648
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Entity Type | Organization
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Legal Business Name | REBECCA POTTER
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 1417 MICHIGAN DR
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City | LAKE WORTH
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State | FL
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Zip | 33461-6059
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Country | US
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Telephone | 561-267-3831
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 MICHIGAN DR
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City | LAKE WORTH
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State | FL
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Zip | 33461-6059
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Country | US
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Telephone | 561-267-3831
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | MS. REBECCA POTTER
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Credential | LMHC
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Telephone | 561-267-3831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH7817
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License Number State | FL
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