Individual
MR. JASON POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
504 MICAH DRIVE, BOX DRAWER M, OLNEY, IL 62450-0913
(618) 395-4306
(618) 395-4507
Mailing address
PO BOX M, 504 MICAH DRIVE, OLNEY, IL 62450-0913
(618) 395-4306
(618) 395-4507
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371095903009
—
IL
Enumeration date
06/30/2008
Last updated
06/30/2008
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