Provider Demographics
NPI:1720573983
Name:MARIA POTTER COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:MARIA POTTER COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-296-0852
Mailing Address - Street 1:13305 S RIDGELAND AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1814
Mailing Address - Country:US
Mailing Address - Phone:708-907-5149
Mailing Address - Fax:708-907-5294
Practice Address - Street 1:13305 S RIDGELAND AVE UNIT C
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1814
Practice Address - Country:US
Practice Address - Phone:708-907-5149
Practice Address - Fax:708-907-5294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)