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General NPI Number Information
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NPI Number | 1952172199
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Entity Type | Individual
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Provider Name | MARK POWERS
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Gender | Male
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 455 MASSACHUSETTS ST
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City | GARY
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State | IN
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Zip | 46402-1314
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Country | US
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Telephone | 219-678-0255
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Fax |
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Provider Business Mailing Address
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Address Line | 7908 MAPLE AVE
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City | GARY
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State | IN
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Zip | 46403-1324
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Country | US
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Telephone | 219-678-0255
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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 | 101Y00000X
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Taxonomy Name | 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 | 347D00000X
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Taxonomy Name | Train
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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