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General NPI Number Information
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NPI Number | 1164742094
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Entity Type | Organization
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Legal Business Name | ROBERT G. POWELL, LCSW, BCD, P.C.
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 471 S. BALDWIN SUITE 3D
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City | WOODLAND PARK
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State | CO
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Zip | 80866-5616
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Country | US
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Telephone | 719-687-7180
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Fax | 719-687-9771
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Provider Business Mailing Address
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Address Line | PO BOX 5616
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City | WOODLAND PARK
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State | CO
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Zip | 80866-5616
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Country | US
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Telephone | 719-687-7180
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Fax | 719-687-9771
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MR. ROBERT G. POWELL
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Credential | LCSW
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Telephone | 719-687-7180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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