Individual
ASHLEY R POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1002 WISHARD BLVD STE 4110, INDIANAPOLIS, IN 46202-4164
(317) 944-8162
(317) 948-0609
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
20043802A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430J83
MEDICARE PTAN
IN
05
—
300095418
—
IN
Enumeration date
07/03/2024
Last updated
10/03/2024
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