Provider Demographics
NPI:1326603481
Name:POWELL, WILLIAM MARK
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
Last Name:POWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 WESTIN DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-7247
Mailing Address - Country:US
Mailing Address - Phone:303-931-7888
Mailing Address - Fax:
Practice Address - Street 1:1584 WESTIN DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-7247
Practice Address - Country:US
Practice Address - Phone:303-931-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health