Provider Demographics
NPI:1336639822
Name:POWELL, CHRISTOPHER JOHN (RBT-45986)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:POWELL
Suffix:
Gender:M
Credentials:RBT-45986
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 VAN GORDON ST APT 3-323
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1227
Mailing Address - Country:US
Mailing Address - Phone:248-420-8087
Mailing Address - Fax:
Practice Address - Street 1:573 VAN GORDON ST APT 3-323
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1227
Practice Address - Country:US
Practice Address - Phone:248-420-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-45986106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician