Provider Demographics
NPI:1992695563
Name:POTENTIAL LLP PLLC
Entity type:Organization
Organization Name:POTENTIAL LLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-828-2788
Mailing Address - Street 1:144 OAKES ST SW APT 1307
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3148
Mailing Address - Country:US
Mailing Address - Phone:616-828-2788
Mailing Address - Fax:616-608-4657
Practice Address - Street 1:5005 PLAINFIELD AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2087
Practice Address - Country:US
Practice Address - Phone:616-828-2788
Practice Address - Fax:616-608-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty