Individual
TYRONE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, HSPP
Contact information
Practice address
620 8TH AVE, TERRE HAUTE, IN 47804-2744
(812) 231-8407
(812) 231-8178
Mailing address
PO BOX 4323, TERRE HAUTE, IN 47804-0323
(812) 231-8323
(812) 231-8400
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041029
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200119420
—
IN
Enumeration date
07/03/2006
Last updated
07/08/2007
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