Provider Demographics
NPI:1275923534
Name:RONALD O POWELL PHD PLLC
Entity Type:Organization
Organization Name:RONALD O POWELL PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-214-3609
Mailing Address - Street 1:8201 164TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7615
Mailing Address - Country:US
Mailing Address - Phone:425-214-3609
Mailing Address - Fax:
Practice Address - Street 1:8201 164TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7615
Practice Address - Country:US
Practice Address - Phone:425-214-3609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001122251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1275923534OtherNATIONAL PLAN AND PROVIDER ENUMERATION