Healthcare Provider Details

I. General information

NPI: 1790212017
Provider Name (Legal Business Name): PATRICIA A POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 EVANGELINE ST
MONROE LA
71201-3749
US

IV. Provider business mailing address

2900 CAMERON ST
MONROE LA
71201-3714
US

V. Phone/Fax

Practice location:
  • Phone: 318-654-7667
  • Fax:
Mailing address:
  • Phone: 318-323-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: