Provider Demographics
NPI:1144343567
Name:POWELL, DUSTIN TED (LPC, MA, CACIII)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:TED
Last Name:POWELL
Suffix:
Gender:M
Credentials:LPC, MA, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1241
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-8241
Mailing Address - Country:US
Mailing Address - Phone:303-838-5406
Mailing Address - Fax:888-805-4990
Practice Address - Street 1:60615 U.S. HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421
Practice Address - Country:US
Practice Address - Phone:303-838-5406
Practice Address - Fax:888-958-1156
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC-6804101YA0400X
101YM0800X
COLPC-6245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health