Provider Demographics
NPI:1841328481
Name:POTTER, MAUREEN REEVES
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:REEVES
Last Name:POTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:MAY
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:305 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4043
Mailing Address - Country:US
Mailing Address - Phone:615-446-3797
Mailing Address - Fax:615-446-3760
Practice Address - Street 1:721 HIGHWAY 46 S
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2565
Practice Address - Country:US
Practice Address - Phone:615-446-3797
Practice Address - Fax:615-446-3760
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNIP5791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLDC0000000404OtherA & D COUNSELOR
TNIP579OtherLCSW
TNLPN0000016664OtherLIC. PRC. NURSE INACTIVE
TN3693253Medicare ID - Type UnspecifiedLCSW