MEDICARE: REBECCA POTTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MH7817	FL

General Provider Information

NPI Number	:	1023470648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBECCA POTTER

Provider Business Mailing Address
First Line	:	1417 MICHIGAN DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6059
Country	:	US
Telephone Number	:	561-267-3831
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 MICHIGAN DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6059
Country	:	US
Telephone Number	:	561-267-3831
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MENTAL HEALTH COUNSELOR
Name	:	MS. REBECCA POTTER
Credential	:	LMHC
Telephone Number	:	561-267-3831

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	03/23/2016

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