Provider Demographics
NPI:1841530235
Name:POWELL, JOHN E (BA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:POWELL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 E 13 MILE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5000
Mailing Address - Country:US
Mailing Address - Phone:586-573-1810
Mailing Address - Fax:158-657-3212
Practice Address - Street 1:12220 E 13 MILE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5000
Practice Address - Country:US
Practice Address - Phone:586-573-1810
Practice Address - Fax:158-657-3212
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health