MEDICARE: ASHLEY POWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1104324961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY POWELL

Provider Business Mailing Address
First Line	:	6444 FAIRWAY AVE SE STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-3073
Country	:	US
Telephone Number	:	971-218-7351
Fax Number	:

Provider Business Practice Location Address
First Line	:	6444 FAIRWAY AVE SE STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-3073
Country	:	US
Telephone Number	:	971-218-7351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	06/20/2024

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Directions to “ ASHLEY POWELL ” Practice Location

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