Provider Demographics
NPI:1962510495
Name:POWELL, HEATHER (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC
Mailing Address - Street 1:2266 MCGILCHRIST ST SE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1019
Mailing Address - Country:US
Mailing Address - Phone:971-237-2588
Mailing Address - Fax:
Practice Address - Street 1:2266 MCGILCHRIST ST SE
Practice Address - Street 2:SUITE 210
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1019
Practice Address - Country:US
Practice Address - Phone:971-237-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1882101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional