Provider Demographics
NPI:1174663173
Name:POWELL, ALBERT E (MA)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:E
Last Name:POWELL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:BERT
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:807 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2808
Mailing Address - Country:US
Mailing Address - Phone:509-455-7654
Mailing Address - Fax:509-455-4112
Practice Address - Street 1:807 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2808
Practice Address - Country:US
Practice Address - Phone:509-455-7654
Practice Address - Fax:509-455-4112
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004402101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health