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General NPI Number Information
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NPI Number | 1407554660
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Entity Type | Individual
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Provider Name | MR. JUSTIN ALLEN POWERS
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Gender | Male
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 627 W FRANKLIN ST
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City | SHELTON
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State | WA
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Zip | 98584-3504
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Country | US
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Telephone | 360-763-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 SIDNEY AVE APT 4-116
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City | PORT ORCHARD
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State | WA
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Zip | 98366-2424
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Country | US
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Telephone | 787-342-3845
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CGCG61413793
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP61653011
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License Number State | WA
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