Provider Demographics
NPI:1265259006
Name:POWELL, KATLYN MARIE
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:MARIE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:TX
Mailing Address - Zip Code:76073-4648
Mailing Address - Country:US
Mailing Address - Phone:972-589-1175
Mailing Address - Fax:
Practice Address - Street 1:732 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:TX
Practice Address - Zip Code:76073-4648
Practice Address - Country:US
Practice Address - Phone:972-589-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00020139106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician