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General NPI Number Information
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NPI Number | 1457485310
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Entity Type | Individual
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Provider Name | LARRY CLINTON POWELL LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 1769 PARK AVE STE 210
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City | SAN JOSE
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State | CA
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Zip | 95126-2025
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Country | US
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Telephone | 408-256-0459
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Fax | 408-457-7190
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Provider Business Mailing Address
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Address Line | 540 PATTON AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-2150
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Country | US
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Telephone | 408-256-0459
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Fax | 408-457-7190
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 46424
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License Number State | CA
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