Provider Demographics
NPI:1437279510
Name:POWELL, RICHARD ANTHONY MICHAEL (APH,NMD,CAC,PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY MICHAEL
Last Name:POWELL
Suffix:
Gender:M
Credentials:APH,NMD,CAC,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 SHOUP AVE W STE 14
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4615
Mailing Address - Country:US
Mailing Address - Phone:208-392-1829
Mailing Address - Fax:888-915-0796
Practice Address - Street 1:676 SHOUP AVE W STE 14
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4615
Practice Address - Country:US
Practice Address - Phone:208-392-1829
Practice Address - Fax:888-915-0796
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 101YP1600X, 103G00000X
IDACC195171100000X, 171100000X
NVA-0833175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No175L00000XOther Service ProvidersHomeopath