Provider Demographics
NPI:1588029359
Name:POWERS, TAMA JO
Entity Type:Individual
Prefix:MRS
First Name:TAMA
Middle Name:JO
Last Name:POWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47567-1514
Mailing Address - Country:US
Mailing Address - Phone:618-562-8380
Mailing Address - Fax:
Practice Address - Street 1:207 E LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:IN
Practice Address - Zip Code:47598-5408
Practice Address - Country:US
Practice Address - Phone:618-562-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral