MEDICARE: RICHARD POWELL PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	6401015750	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	829999	OTHER		NATIONAL BOARD FOR CERTIFIED COUNSELORS
2	6401017570	OTHER	MI	STATE OF MICHIGAN
3	13945941	OTHER		CAQH

General Provider Information

NPI Number	:	1023553377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD POWELL PHD

Provider Business Mailing Address
First Line	:	30821 BARRINGTON ST
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1871
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 SOUTH LIVERNOIS, SUITE 100
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4404
Country	:	US
Telephone Number	:	248-467-3550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	01/31/2021

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Directions to “ RICHARD POWELL PHD” Practice Location

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