Provider Demographics
NPI:1588116065
Name:POWELL, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 S 1300 E STE 500
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4375
Mailing Address - Country:US
Mailing Address - Phone:385-262-4048
Mailing Address - Fax:801-303-7319
Practice Address - Street 1:2150 S 1300 E STE 500
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-4375
Practice Address - Country:US
Practice Address - Phone:385-262-4048
Practice Address - Fax:801-303-7319
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12224266-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical