Provider Demographics
NPI:1639260748
Name:POWELL, LAURIE JEAN (MSSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:JEAN
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSSW LCSW
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:POWELL
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSW LCSW
Mailing Address - Street 1:3810 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-9007
Mailing Address - Country:US
Mailing Address - Phone:901-259-9125
Mailing Address - Fax:901-369-1433
Practice Address - Street 1:3810 WINCHESTER RD
Practice Address - Street 2:SOUTHEAST MENTAL HEALTH CENTER
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-9007
Practice Address - Country:US
Practice Address - Phone:901-369-1420
Practice Address - Fax:901-369-1433
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4104104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical