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General NPI Number Information
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NPI Number | 1992695563
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Entity Type | Organization
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Legal Business Name | POTENTIAL LLP PLLC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 5005 PLAINFIELD AVE NE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-2087
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Country | US
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Telephone | 616-828-2788
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Fax | 616-608-4657
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Provider Business Mailing Address
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Address Line | 144 OAKES ST SW APT 1307
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3148
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Country | US
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Telephone | 616-828-2788
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Fax | 616-608-4657
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | AMANDA MILLER
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Credential |
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Telephone | 616-828-2788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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