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General NPI Number Information
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NPI Number | 1043564099
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Entity Type | Individual
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Provider Name | TINA M POWELL LPC
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Gender | Female
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 1305 S COUNTRY CLUB RD
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City | MUSKOGEE
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State | OK
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Zip | 74403-7802
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Country | US
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Telephone | 918-530-2342
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 392
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City | WAGONER
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State | OK
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Zip | 74477-0392
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Country | US
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Telephone | 918-530-2342
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5383
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License Number State | OK
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