Provider Demographics
NPI:1346352564
Name:POWELL, TOBY
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:
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 1:1110 ELDON BAKER DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1923
Mailing Address - Country:US
Mailing Address - Phone:810-744-3600
Mailing Address - Fax:
Practice Address - Street 1:2929 COVINGTON CT
Practice Address - Street 2:SUITE 50
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4941
Practice Address - Country:US
Practice Address - Phone:517-371-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010179101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical