Provider Demographics
NPI:1568048098
Name:POWELL, DEEDRA RENE (LMSW LCSW)
Entity Type:Individual
Prefix:
First Name:DEEDRA
Middle Name:RENE
Last Name:POWELL
Suffix:
Gender:F
Credentials:LMSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 ZEPHYR GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7093
Mailing Address - Country:US
Mailing Address - Phone:832-778-0276
Mailing Address - Fax:
Practice Address - Street 1:3315 ZEPHYR GLEN WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7093
Practice Address - Country:US
Practice Address - Phone:832-778-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX63840OtherLCSW LICENSE NUMBER