Healthcare Provider Details

I. General information

NPI: 1477526549
Provider Name (Legal Business Name): LINDSAY NICHOLE POWELSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 JOHNSTON DR
RAYMORE MO
64083-9680
US

IV. Provider business mailing address

1307 JOHNSTON DR
RAYMORE MO
64083-9680
US

V. Phone/Fax

Practice location:
  • Phone: 816-592-1900
  • Fax:
Mailing address:
  • Phone: 816-592-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2004024728
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2004024728
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: