Provider Demographics
NPI:1518929330
Name:POWERS, VIANN MCCULLION (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:VIANN
Middle Name:MCCULLION
Last Name:POWERS
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10805 DECKER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:CO
Mailing Address - Zip Code:81069
Mailing Address - Country:US
Mailing Address - Phone:719-248-0913
Mailing Address - Fax:719-489-2750
Practice Address - Street 1:2 NORTH PARKWAY
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:CO
Practice Address - Zip Code:81019
Practice Address - Country:US
Practice Address - Phone:719-289-2758
Practice Address - Fax:719-489-2758
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1389101YP2500X
VA2442101YP2500X
VA0215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid