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General NPI Number Information
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NPI Number | 1275923534
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Entity Type | Organization
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Legal Business Name | RONALD O POWELL PHD PLLC
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 8201 164TH AVE NE STE 200
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City | REDMOND
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State | WA
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Zip | 98052-7615
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Country | US
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Telephone | 425-214-3609
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Fax |
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Provider Business Mailing Address
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Address Line | 8201 164TH AVE NE STE 200
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City | REDMOND
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State | WA
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Zip | 98052-7615
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Country | US
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Telephone | 425-214-3609
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROALD O POWELL
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Credential | PHD
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Telephone | 425-214-3609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PY00001122
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License Number State | WA
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