Provider Demographics
NPI:1285753251
Name:POWERS, PATRICK D (LPC-MH)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:D
Last Name:POWERS
Suffix:
Gender:M
Credentials:LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-5193
Mailing Address - Country:US
Mailing Address - Phone:605-641-1843
Mailing Address - Fax:
Practice Address - Street 1:2719 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-5193
Practice Address - Country:US
Practice Address - Phone:605-641-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD101YM0800XMedicaid