MEDICARE: ANNIE M POWELL LCDC, MHPS, RSPS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171400000X	Health & Wellness Coach
2	171M00000X	Case Manager/Care Coordinator
3	172V00000X	Community Health Worker
4	175T00000X	Peer Specialist
5	101YA0400X	Addiction (Substance Use Disorder) Counselor

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	:	1861989782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE M POWELL LCDC, MHPS, RSPS

Provider Business Mailing Address
First Line	:	PO BOX 3472
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-9472
Country	:	US
Telephone Number	:	214-883-9520
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 SOUTHRIDGE CT STE 207
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-4284
Country	:	US
Telephone Number	:	877-257-2282
Fax Number	:	877-257-2282

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

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	05/13/2024

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Directions to “ ANNIE M POWELL LCDC, MHPS, RSPS” Practice Location

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