Basic Information
| Provider Information | |||||||||
| NPI: | 1639201759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWERS | ||||||||
| FirstName: | CASEY | ||||||||
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| Credential: | MBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | RESOURCE MANAGEMENT | ||||||||
| Address2: | 210 E. MAIN ST | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804367211 | ||||||||
| FaxNumber: | 5802725757 | ||||||||
| Practice Location | |||||||||
| Address1: | MEDICAL FAMILY THERAPY | ||||||||
| Address2: | 817 E. 6TH ST. | ||||||||
| City: | TISHOMINGO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803872719 | ||||||||
| FaxNumber: | 5803872728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4386 | OK | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101Y00000X | 4386 | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.