Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan Potter, LCSW

Individual provider Clinical Social Worker · NPI 1275188799

Ethan Potter, LCSW is a Clinical Social Worker in Springfield, Missouri. Qualified in 2019, 7 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
7
Licensed in
MO
In the registry since
2019
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

1722 S Glenstone Ave Ste H
Springfield, MO 65804-1513
Phone: (417) 224-7806
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 2021024924 (MO)
Clinical Social Worker Taxonomy 1041C0700X

Record details

NPI number1275188799
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedAugust 2, 2019
Last updated in NPPESJune 27, 2024
Certification dateJune 27, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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