Provider Demographics
NPI:1639201759
Name:POWERS, CASEY (MBS)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:POWERS
Suffix:
Gender:M
Credentials:MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RESOURCE MANAGEMENT
Mailing Address - Street 2:210 E. MAIN ST
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-436-7211
Mailing Address - Fax:580-272-5757
Practice Address - Street 1:MEDICAL FAMILY THERAPY
Practice Address - Street 2:817 E. 6TH ST.
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460
Practice Address - Country:US
Practice Address - Phone:580-387-2719
Practice Address - Fax:580-387-2728
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
4386101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health