Provider Demographics
NPI:1952172199
Name:POWERS, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:POWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-1324
Mailing Address - Country:US
Mailing Address - Phone:219-678-0255
Mailing Address - Fax:
Practice Address - Street 1:455 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-1314
Practice Address - Country:US
Practice Address - Phone:219-678-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No347D00000XTransportation ServicesTrain