Healthcare Provider Details

I. General information

NPI: 1477932226
Provider Name (Legal Business Name): TERRELL POWELL LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 112TH AVE NE SUITE 202
BELLEVUE WA
98004-2953
US

IV. Provider business mailing address

2227 112TH AVE NE SUITE NUMBER 202
BELLEVUE WA
98004-2953
US

V. Phone/Fax

Practice location:
  • Phone: 425-452-8036
  • Fax: 425-452-8038
Mailing address:
  • Phone: 425-452-8036
  • Fax: 425-452-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60471820
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: