Provider Demographics
NPI:1669156063
Name:POWERS, EMILY MAY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MAY
Last Name:POWERS
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 1:6655 JACKSON RD UNIT 208
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9540
Mailing Address - Country:US
Mailing Address - Phone:260-797-1300
Mailing Address - Fax:
Practice Address - Street 1:103 E LIBERTY ST STE 203
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2136
Practice Address - Country:US
Practice Address - Phone:260-797-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851115393104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker