Provider Demographics
NPI:1376704296
Name:POWERS, MICHAEL DANIEL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:POWERS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5081 SAMISH WAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-8963
Mailing Address - Country:US
Mailing Address - Phone:360-920-8121
Mailing Address - Fax:
Practice Address - Street 1:1116 KEY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5232
Practice Address - Country:US
Practice Address - Phone:360-920-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 60453276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038668Medicaid