MEDICARE: LAURIE POWELL LCSW

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	1041C0700X	Clinical Social Worker	CSW.09923468	CO

General Provider Information

NPI Number	:	1053681437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE POWELL LCSW

Provider Business Mailing Address
First Line	:	100 ARAPAHOE AVE STE 12
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5862
Country	:	US
Telephone Number	:	970-279-1831
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ARAPAHOE AVE STE 12
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5862
Country	:	US
Telephone Number	:	970-279-1831
Fax Number	:

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

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	11/03/2022

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