MEDICARE: REBECCA JUNE POTTER LMHC

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	101YM0800X	Mental Health Counselor	MH7817	FL

General Provider Information

NPI Number	:	1588848287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JUNE POTTER LMHC

Provider Business Mailing Address
First Line	:	720 LUCERNE AVE UNIT 761
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-3892
Country	:	US
Telephone Number	:	561-267-3831
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 LAKE WORTH RD STE 210
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2400
Country	:	US
Telephone Number	:	561-267-3831
Fax Number	:	561-965-9161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	05/05/2022

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