Ryan Gerald Potempa, MS, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

166.001366 Issued in IL

Practice address

7617 N Villa Wood LN
Peoria, IL 61614-1588

Phone

(309) 693-8200

NPI assigned

Aug 1, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Joy Miller

  • Professional Counselor
  • Peoria, IL
  • NPI 1740471432
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1114441128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7617 N VILLA WOOD LN",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616141588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7617 N VILLA WOOD LN",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616141588",
            "telephone_number": "309-693-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTEMPA",
        "first_name": "RYAN",
        "middle_name": "GERALD",
        "name_prefix": "Mr.",
        "credential": "MS, LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-01",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166.001366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Peoria, IL
• Providers in Peoria, IL by specialty
• Marriage & Family Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.