Provider Demographics
NPI:1821273566
Name:POWELL, LEAH (PHD, HSPP)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4323
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-0323
Mailing Address - Country:US
Mailing Address - Phone:812-231-8315
Mailing Address - Fax:812-231-8442
Practice Address - Street 1:1211 E NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2717
Practice Address - Country:US
Practice Address - Phone:812-448-8801
Practice Address - Fax:812-446-5302
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200889860Medicaid