Provider Demographics
NPI:1780727966
Name:POWELL, LARRY D (LCPC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:D
Last Name:POWELL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4214
Mailing Address - Country:US
Mailing Address - Phone:406-231-2102
Mailing Address - Fax:
Practice Address - Street 1:116 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-2031
Practice Address - Country:US
Practice Address - Phone:406-231-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT982101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT745183OtherBLUE CROSS BLUE SHIELD
MT0254048Medicaid