Provider Demographics
NPI:1851998546
Name:POWELL, JOHN (LMHC, MS, NCC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:LMHC, MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1319
Mailing Address - Country:US
Mailing Address - Phone:802-391-9104
Mailing Address - Fax:
Practice Address - Street 1:100 S HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1319
Practice Address - Country:US
Practice Address - Phone:802-391-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134260101YM0800X
FLMH21802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health