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General NPI Number Information
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NPI Number | 1962795526
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Entity Type | Individual
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Provider Name | THOMAS M POTOSKI LCPC
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Gender | Male
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 4 DUNCAN DR SUITE C
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1083
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Country | US
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Telephone | 815-662-7757
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Fax | 815-928-9335
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Provider Business Mailing Address
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Address Line | PO BOX 870
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City | BOURBONNAIS
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State | IL
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Zip | 60914-6870
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Country | US
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Telephone | 815-662-7757
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Fax | 815-928-9335
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-001413
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License Number State | IL
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