Provider Demographics
NPI:1861989782
Name:POWELL, ANNIE M (LCDC, MHPS, RSPS)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:M
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCDC, MHPS, RSPS
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 3472
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9472
Mailing Address - Country:US
Mailing Address - Phone:214-883-9520
Mailing Address - Fax:
Practice Address - Street 1:1236 SOUTHRIDGE CT STE 207
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4284
Practice Address - Country:US
Practice Address - Phone:877-257-2282
Practice Address - Fax:877-257-2282
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX380106001Medicaid