Provider Demographics
NPI:1770824484
Name:POWELL, ADA RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:RUTH
Last Name:POWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E CAPITOL AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3159
Mailing Address - Country:US
Mailing Address - Phone:605-494-0531
Mailing Address - Fax:605-494-0562
Practice Address - Street 1:207 E CAPITOL AVE STE 206
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3159
Practice Address - Country:US
Practice Address - Phone:605-494-0531
Practice Address - Fax:605-494-0562
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD546103T00000X
OK918103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist