Provider Demographics
NPI:1386095214
Name:POWELL, JAMES (SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 S BARNETT SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5334
Mailing Address - Country:US
Mailing Address - Phone:318-436-9483
Mailing Address - Fax:
Practice Address - Street 1:1495 FRAZIER RD
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-1632
Practice Address - Country:US
Practice Address - Phone:318-202-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11848101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11848OtherSOCIAL WORK