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General NPI Number Information
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NPI Number | 1891342770
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Entity Type | Individual
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Provider Name | JUSIAH PROWELL MS
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Gender | Male
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Dates
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Enumeration Date | 08/24/2019
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 201 ROCKY SLOPE RD APT 409
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City | GREENVILLE
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State | SC
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Zip | 29607-3949
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Country | US
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Telephone | 469-834-3955
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16101
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City | GREENVILLE
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State | SC
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Zip | 29606-7101
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Country | US
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Telephone | 469-834-3955
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 128170
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License Number State | IA
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