Provider Demographics
NPI:1275154429
Name:POWELL, BILLIE (LPC)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E BRIDGEPORT PKWY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-5918
Mailing Address - Country:US
Mailing Address - Phone:602-618-9595
Mailing Address - Fax:
Practice Address - Street 1:2730 S VAL VISTA DR STE 135
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1681
Practice Address - Country:US
Practice Address - Phone:480-730-6222
Practice Address - Fax:480-889-5566
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19325101YP2500X
AZLAC-17531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional