Healthcare Provider Details

I. General information

NPI: 1548096480
Provider Name (Legal Business Name): KRISTA POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 WATERDAM RD STE 210
MC MURRAY PA
15317-2573
US

IV. Provider business mailing address

157 WATERDAM RD STE 210
MC MURRAY PA
15317-2573
US

V. Phone/Fax

Practice location:
  • Phone: 724-271-8989
  • Fax:
Mailing address:
  • Phone: 724-271-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC017438
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: