Provider Demographics
NPI:1265880280
Name:POWELL, LEA (MFTC)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40424
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-0424
Mailing Address - Country:US
Mailing Address - Phone:720-281-9041
Mailing Address - Fax:
Practice Address - Street 1:4340 E KENTUCKY AVE STE 260
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2071
Practice Address - Country:US
Practice Address - Phone:720-281-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist