=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548183445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON MICHAEL POWERS SUDRC2
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2026
-----------------------------------------------------
Last Update Date | 07/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6035 MURPHY WAY
-----------------------------------------------------
City | MALIBU
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90265-4490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-479-4462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 817 COUNTRY CLUB DR APT 8
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-6636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-313-4123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 22973
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------