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General NPI Number Information
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NPI Number | 1548663107
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Entity Type | Organization
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Legal Business Name | KALYNN G. POTTER, LLC
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 945 S ROCHESTER RD SUITE 101
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-2762
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Country | US
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Telephone | 248-434-8227
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Fax |
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Provider Business Mailing Address
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Address Line | 2907 ADDISON CIR S
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City | ROCHESTER HILLS
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State | MI
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Zip | 48306-4924
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Country | US
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Telephone | 248-563-1743
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Fax |
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Authorized Official
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Title or Position | SELF EMPLOYED
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Name | KALYNN POTTER
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Credential |
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Telephone | 248-563-1743
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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 | 6401011359
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License Number State | MI
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