Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 680 | MT |
Y | 1041C0700X | Clinical Social Worker | 557 | MT |
NPI | 1003905894 |
---|---|
Provider Name | David B. Powell |
First Address | Livingston, MT 59047-8506 |
Second Address | Livingston, MT 59047-8506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 04/12/2018 |