Provider Demographics
NPI:1053599753
Name:POTTER, MICHELLE (LCPC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 LARKIN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4405
Mailing Address - Country:US
Mailing Address - Phone:847-697-2400
Mailing Address - Fax:847-697-2438
Practice Address - Street 1:2075 FOXFIELD RD STE 202
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1402
Practice Address - Country:US
Practice Address - Phone:630-377-3535
Practice Address - Fax:630-377-6703
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180002063OtherLCPC LICENSE NBR