Provider Demographics
NPI:1386716355
Name:POWELL, WILLIAM CARRINGTON JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CARRINGTON
Last Name:POWELL
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NE 7TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1451
Mailing Address - Country:US
Mailing Address - Phone:541-472-8222
Mailing Address - Fax:
Practice Address - Street 1:1201 NE 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1451
Practice Address - Country:US
Practice Address - Phone:541-472-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR118446Medicare UPIN