Provider Demographics
NPI:1225630817
Name:POTTER, JAYLA (RBT)
Entity type:Individual
Prefix:
First Name:JAYLA
Middle Name:
Last Name:POTTER
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5517
Mailing Address - Country:US
Mailing Address - Phone:765-277-4401
Mailing Address - Fax:
Practice Address - Street 1:3771 S A ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-6053
Practice Address - Country:US
Practice Address - Phone:765-598-4197
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-20-138838106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician