Basic Information
| Provider Information | |||||||||
| NPI: | 1265687701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWERS | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2810 E DEL MAR BLVD STE 12 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911076709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493298677 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2810 E DEL MAR BLVD STE 12 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911076709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265850041 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2008 | ||||||||
| LastUpdateDate: | 03/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103TC0700X | 29991 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.