Provider Demographics
NPI:1730261777
Name:POWERS, MYIA L (LCSW)
Entity type:Individual
Prefix:
First Name:MYIA
Middle Name:L
Last Name:POWERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N JUNIPER BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:MT
Mailing Address - Zip Code:59932-9739
Mailing Address - Country:US
Mailing Address - Phone:406-250-6379
Mailing Address - Fax:406-393-2014
Practice Address - Street 1:375 N JUNIPER BAY RD
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:MT
Practice Address - Zip Code:59932-9739
Practice Address - Country:US
Practice Address - Phone:406-250-6379
Practice Address - Fax:406-393-2014
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-3451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000070601OtherBCBS
MT0502736Medicaid
MT0502736Medicaid