Provider Demographics
NPI:1518748904
Name:POWELL, MISSY ANN (LMFT-C)
Entity Type:Individual
Prefix:
First Name:MISSY
Middle Name:ANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:LMFT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10802 QUAIL PLAZA DR STE 208
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3121
Mailing Address - Country:US
Mailing Address - Phone:405-889-3571
Mailing Address - Fax:
Practice Address - Street 1:10802 QUAIL PLAZA DR STE 208
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3121
Practice Address - Country:US
Practice Address - Phone:405-889-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LMFTCANDIDATE11794106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist