| Potential LLP PLLC | |
|
5005 Plainfield Ave Ne Ste 100 Grand Rapids MI 49525-2087 | |
| (616) 828-2788 | |
| (616) 608-4657 |
| Full Name | Potential LLP PLLC |
|---|---|
| Speciality | Psychologist |
| Location | 5005 Plainfield Ave Ne Ste 100, Grand Rapids, Michigan |
| Authorized Official Name and Position | Amanda Miller (OWNER/PROVIDER) |
| Authorized Official Contact | 6168282788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Potential LLP PLLC 144 Oakes St Sw Apt 1307 Grand Rapids MI 49503-3148 Ph: (616) 828-2788 | Potential LLP PLLC 5005 Plainfield Ave Ne Ste 100 Grand Rapids MI 49525-2087 Ph: (616) 828-2788 |
| NPI Number | 1992695563 |
|---|---|
| Provider Enumeration Date | 07/07/2025 |
| Last Update Date | 07/07/2025 |
| Certification Date | 07/07/2025 |
| Medicare PECOS PAC ID | 9537664701 |
|---|---|
| Medicare Enrollment ID | O20250926003271 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992695563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | () | Primary |
| Provider Name | Amanda Jane Miller |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1407349269 PECOS PAC ID: 0446755615 Enrollment ID: I20250926003447 |
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