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General NPI Number Information
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NPI Number | 1346852043
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Entity Type | Individual
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Provider Name | KAORU A POWELL PHD
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Gender | Female
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 1444 MANSFIELD AVE
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City | MISSOULA
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State | MT
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Zip | 59812-9794
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Country | US
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Telephone | 406-219-5938
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Fax |
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Provider Business Mailing Address
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Address Line | 201 TYLER WAY
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City | LOLO
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State | MT
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Zip | 59847-9794
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Country | US
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Telephone | 808-228-9086
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY-PSY-LIC-4549
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License Number State | MT
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