Basic Information
| Provider Information | |||||||||
| NPI: | 1528583432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | TRISHA | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3241 N COLEMAN RD | ||||||||
| Address2: | |||||||||
| City: | COLEMAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486189512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9892598031 | ||||||||
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| Practice Location | |||||||||
| Address1: | 218 FAST ICE DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486426167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896312320 | ||||||||
| FaxNumber: | 9896319903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2017 | ||||||||
| LastUpdateDate: | 08/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801101358 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.