Healthcare Provider Details

I. General information

NPI: 1285972034
Provider Name (Legal Business Name): DENICIA POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 N MLK BLVD STE 212
N LAS VEGAS NV
89032-7676
US

IV. Provider business mailing address

5249 DAWN BREAK CANYON ST
N LAS VEGAS NV
89031-6627
US

V. Phone/Fax

Practice location:
  • Phone: 702-321-5599
  • Fax:
Mailing address:
  • Phone: 702-321-5599
  • Fax: 702-657-9892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: