Provider Demographics
NPI:1912770553
Name:POWELL, JEFFREY (ADC-T)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:ADC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 MARQUETTE AVE APT 2408
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-4133
Mailing Address - Country:US
Mailing Address - Phone:763-290-2736
Mailing Address - Fax:952-516-5161
Practice Address - Street 1:705 42ND AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1711
Practice Address - Country:US
Practice Address - Phone:612-504-2047
Practice Address - Fax:952-516-5161
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171400000XOther Service ProvidersHealth & Wellness Coach
No177F00000XOther Service ProvidersLodging