Basic Information
| Provider Information | |||||||||
| NPI: | 1619407947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWERS | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC-CR, CAMSII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E WHEELING AVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437252510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404321800 | ||||||||
| FaxNumber: | 7404329299 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 S 12TH ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437252449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404321800 | ||||||||
| FaxNumber: | 7404329299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E.1700185 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 2961568 | 05 | OH | MEDICAID |