Basic Information
| Provider Information | |||||||||
| NPI: | 1134669757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | MYRISSA | ||||||||
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| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 659 BOULEVARD ST | ||||||||
| Address2: | SOCIAL SERVICES | ||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303433311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 659 BOULEVARD ST | ||||||||
| Address2: | SOCIAL SERVICES | ||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303433311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2017 | ||||||||
| LastUpdateDate: | 03/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S1600573 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.