MEDICARE: MR. WILLIAM CARRINGTON POWELL JR. 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	2795	OR

General Provider Information

NPI Number	:	1386716355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM CARRINGTON POWELL JR. LCSW

Provider Business Mailing Address
First Line	:	1201 NE 7TH ST
Second Line	:	SUITE C
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1451
Country	:	US
Telephone Number	:	541-472-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 NE 7TH ST
Second Line	:	SUITE C
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1451
Country	:	US
Telephone Number	:	541-472-8222
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/21/2008

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