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General NPI Number Information
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NPI Number | 1760662589
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Entity Type | Individual
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Provider Name | RANDY MONROE POWELL M.ED
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Gender | Male
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 3834 S 19TH ST
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City | TACOMA
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State | WA
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Zip | 98405-2016
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Country | US
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Telephone | 253-396-5919
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Fax | 253-396-5913
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Provider Business Mailing Address
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Address Line | 1755 SW COZY LN
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City | PORT ORCHARD
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State | WA
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Zip | 98367-9321
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Country | US
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Telephone | 360-876-3113
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Fax | 253-396-5913
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 60145921
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License Number State | WA
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