Healthcare Provider Details

I. General information

NPI: 1235234816
Provider Name (Legal Business Name): LLOYD JAMES POWELL CARS 03050743
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N MAIN ST
ALTURAS CA
96101
US

IV. Provider business mailing address

HC4 BOX 40529
ALTURAS CA
96101
US

V. Phone/Fax

Practice location:
  • Phone: 530-233-6312
  • Fax: 530-233-5311
Mailing address:
  • Phone: 530-233-4983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number03050743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: