Provider Demographics
NPI:1972926830
Name:POWELL, TANYA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 MCCULLOCH BLVD N # D165
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:276 LAKE HAVASU AVE S APT B28
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6519
Practice Address - Country:US
Practice Address - Phone:928-566-4637
Practice Address - Fax:928-863-7078
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional