Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0373 | KY |
N | 101YM0800X | Mental Health Counselor | 1740 | KY |
Y | 1041C0700X | Clinical Social Worker | 1740 | KY |
NPI | 1003939653 |
---|---|
Provider Name | Ms. Terri J Powell |
First Address | Lexington, KY 40504-3655 |
Second Address | Lexington, KY 40504-3655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K052780 | MEDICARE PTAN (01) | KY |