Provider Demographics
NPI:1740877083
Name:POWELL, BENJAMIN ALEX (PLPC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALEX
Last Name:POWELL
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10040 I 10 SERVICE RD STE C
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-2701
Mailing Address - Country:US
Mailing Address - Phone:504-462-2602
Mailing Address - Fax:
Practice Address - Street 1:10040 I 10 SERVICE RD STE C
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2701
Practice Address - Country:US
Practice Address - Phone:504-462-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LAPLC9234101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator