Provider Demographics
NPI:1851453567
Name:POWELL, MAUREEN S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:S
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11924 JUSTICE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2372
Mailing Address - Country:US
Mailing Address - Phone:225-343-4421
Mailing Address - Fax:225-291-9463
Practice Address - Street 1:11924 JUSTICE AVE STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2372
Practice Address - Country:US
Practice Address - Phone:225-343-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T634Medicare ID - Type Unspecified