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NPI Code Detail

MEDICARE: MS. KELLI MICHELLE POWELL MED, LPC-INTERN

MEDICARE: MS. KELLI MICHELLE POWELL MED, LPC-INTERN
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
1101YM0800XMental Health Counselor77586TX

General Provider Information

NPI Number : 1326664004
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLI MICHELLE POWELL MED, LPC-INTERN
Provider Business Mailing Address
First Line : 416 E MAIN ST
Second Line :
City : DENISON
State : TX
Zip : 75021-2822
Country : US
Telephone Number : 903-465-6344
Fax Number :
Provider Business Practice Location Address
First Line : 416 E MAIN ST
Second Line :
City : DENISON
State : TX
Zip : 75021-2822
Country : US
Telephone Number : 903-465-6344
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2020
Last Update Date : 06/18/2020

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