Provider Demographics
NPI:1922207505
Name:POWELL, DARREN RANDOLPH (LPC MA)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:RANDOLPH
Last Name:POWELL
Suffix:
Gender:M
Credentials:LPC MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 WEST BLANCO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-885-6001
Mailing Address - Fax:210-492-2630
Practice Address - Street 1:1132 WEST BLANCO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-885-6001
Practice Address - Fax:210-492-2630
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional