Provider Demographics
NPI:1164742094
Name:ROBERT G. POWELL, LCSW, BCD, P.C.
Entity Type:Organization
Organization Name:ROBERT G. POWELL, LCSW, BCD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-687-7180
Mailing Address - Street 1:PO BOX 5616
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-5616
Mailing Address - Country:US
Mailing Address - Phone:719-687-7180
Mailing Address - Fax:719-687-9771
Practice Address - Street 1:471 S. BALDWIN
Practice Address - Street 2:SUITE 3D
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80866-5616
Practice Address - Country:US
Practice Address - Phone:719-687-7180
Practice Address - Fax:719-687-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
506828Medicare PIN