Healthcare Provider Details

I. General information

NPI: 1790607448
Provider Name (Legal Business Name): AMELIA POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 NW 178TH ST OFC 1
EDMOND OK
73012-9150
US

IV. Provider business mailing address

1709 VICTORIA PL
EDMOND OK
73003-3851
US

V. Phone/Fax

Practice location:
  • Phone: 405-320-9150
  • Fax:
Mailing address:
  • Phone: 405-508-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number13548
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: