Provider Demographics
NPI:1790277259
Name:POWERS POWERS & SLAGLE LLC
Entity Type:Organization
Organization Name:POWERS POWERS & SLAGLE LLC
Other - Org Name:HEALING HEARTS OF SW OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSBS, LPC
Authorized Official - Phone:580-730-0232
Mailing Address - Street 1:1930 NW FERRIS AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-5629
Mailing Address - Country:US
Mailing Address - Phone:580-730-0232
Mailing Address - Fax:
Practice Address - Street 1:1930 NW FERRIS AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-5629
Practice Address - Country:US
Practice Address - Phone:580-730-0232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty