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General NPI Number Information
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NPI Number | 1154810208
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Entity Type | Individual
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Provider Name | JOSEPH POWELL LCDC, RSPS, PSS
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Gender | Male
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 05/13/2024
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Provider Practice Location Address
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Address Line | 1236 SOUTHRIDGE CT STE 207
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City | HURST
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State | TX
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Zip | 76053-4284
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Country | US
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Telephone | 877-257-2282
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Fax | 877-257-2282
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Provider Business Mailing Address
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Address Line | PO BOX 3472
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City | COPPELL
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State | TX
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Zip | 75019-9472
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Country | US
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Telephone | 214-476-6066
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1997
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License Number State | TX
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