Provider Demographics
NPI:1699241000
Name:POWERS, MIKELLE (MSW, LISW-S)
Entity type:Individual
Prefix:
First Name:MIKELLE
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E CAMPUS VIEW BLVD
Mailing Address - Street 2:STE 250 PMB 545
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4682
Mailing Address - Country:US
Mailing Address - Phone:614-594-8759
Mailing Address - Fax:614-748-0625
Practice Address - Street 1:100 E CAMPUS VIEW BLVD
Practice Address - Street 2:STE 250 PMB 545
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4682
Practice Address - Country:US
Practice Address - Phone:614-594-8759
Practice Address - Fax:614-748-0625
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health