Provider Demographics
NPI:1689824492
Name:SHAWN POWELL, PH.D., LLC
Entity Type:Organization
Organization Name:SHAWN POWELL, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-232-0155
Mailing Address - Street 1:152 N DURBIN ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1931
Mailing Address - Country:US
Mailing Address - Phone:307-232-0155
Mailing Address - Fax:307-232-0156
Practice Address - Street 1:152 N DURBIN ST
Practice Address - Street 2:SUITE 308
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1931
Practice Address - Country:US
Practice Address - Phone:307-232-0155
Practice Address - Fax:307-232-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY412103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY124043900Medicaid