Provider Demographics
NPI:1225541535
Name:POWELL, LIBERTY (CSW)
Entity Type:Individual
Prefix:
First Name:LIBERTY
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 SHADEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-8845
Mailing Address - Country:US
Mailing Address - Phone:910-490-0880
Mailing Address - Fax:
Practice Address - Street 1:1100 WALNUT ST STE 14
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-2968
Practice Address - Country:US
Practice Address - Phone:270-684-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2529481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical