Individual
ETHAN POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1722 S GLENSTONE AVE STE H, SPRINGFIELD, MO 65804-1513
(417) 224-7806
Mailing address
2135 E INDEPENDENCE ST # 1033, SPRINGFIELD, MO 65804-3749
(417) 224-7806
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2021024924
MO
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
08/02/2019
Last updated
06/27/2024
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