Provider Demographics
NPI:1750897641
Name:POWERS, JIMMY L JR (LPCC)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:L
Last Name:POWERS
Suffix:JR
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 STATE ROUTE 63
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9371
Mailing Address - Country:US
Mailing Address - Phone:513-932-1211
Mailing Address - Fax:
Practice Address - Street 1:608 KENNEDY ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-5627
Practice Address - Country:US
Practice Address - Phone:937-470-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1700483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health