Provider Demographics
NPI:1396764916
Name:POWELL, JIMMIE C (LCSW)
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:C
Last Name:POWELL
Suffix:
Gender:F
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:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-0939
Mailing Address - Country:US
Mailing Address - Phone:409-949-3406
Mailing Address - Fax:409-949-3492
Practice Address - Street 1:9850-C EMMETT F. LOWRY EXPY
Practice Address - Street 2:SUITE C-102
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591
Practice Address - Country:US
Practice Address - Phone:409-949-3406
Practice Address - Fax:409-949-3492
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07596104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker