Provider Demographics
NPI:1275414641
Name:POWELL, TYRONE (SUDP)
Entity type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 23RD AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2309
Mailing Address - Country:US
Mailing Address - Phone:206-219-5986
Mailing Address - Fax:
Practice Address - Street 1:113 23RD AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2309
Practice Address - Country:US
Practice Address - Phone:206-219-5986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)