Individual
FALLON RAE POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1468 N MUSTANG RD, MUSTANG, OK 73064-7214
(716) 796-3416
Mailing address
185 ROUTE 70, TOMS RIVER, NJ 08755-0906
(732) 806-0091
(732) 813-8001
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
103K00000X
Behavior Analyst
1-26-87676
OK
Other
Enumeration date
07/12/2022
Last updated
04/21/2026
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