MEDICARE: DARREN 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	101YM0800X	Mental Health Counselor	CSW09923200	CO
2	101YM0800X	Mental Health Counselor	I-05932	NM
3	101YM0800X	Mental Health Counselor	C-09887	NM
4	1041C0700X	Clinical Social Worker	C-09887	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336132356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN POWELL LCSW

Provider Business Mailing Address
First Line	:	1001 W BROADWAY STE D
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5638
Country	:	US
Telephone Number	:	505-325-0238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 W BROADWAY STE D
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5638
Country	:	US
Telephone Number	:	505-325-0238
Fax Number	:

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/03/2019

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Directions to “ DARREN POWELL LCSW” Practice Location

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