Provider Demographics
NPI:1043958895
Name:MIDSOMMER PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:MIDSOMMER PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:POTESTA
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC, NCC
Authorized Official - Phone:330-962-4943
Mailing Address - Street 1:1530 S STATE ST APT 1014
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1530 S STATE ST APT 1014
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2987
Practice Address - Country:US
Practice Address - Phone:330-962-4943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)