Potts, Jason

Potts, Jason is an individual health care provider with primary practice located at 504 Micah Drive Box Drawer M, Olney IL 62450-0913. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Potts, Jason can be contacted via phone (618) 395-4306.

Contact Information

Primary practice address
504 Micah Drive Box Drawer M Olney IL 62450-0913
Phone: (618) 395-4306
Fax: (618) 395-4507
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1326200460
LBN Legal business name Potts, Jason
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2008
Last updated Jun 30th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326200460 NPPES
Illinois MEDICAID 371095903009

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