Provider Demographics
NPI:1003080359
Name:POWELL, GERALD B (PHD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:B
Last Name:POWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 RYALND AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-5126
Mailing Address - Country:US
Mailing Address - Phone:513-242-3894
Mailing Address - Fax:440-243-6530
Practice Address - Street 1:1118 RYALND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-5126
Practice Address - Country:US
Practice Address - Phone:513-242-3894
Practice Address - Fax:440-243-6530
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3017103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist