Provider Demographics
NPI:1871167627
Name:POWERS, STEPHEN PHILIP
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PHILIP
Last Name:POWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-9530
Mailing Address - Country:US
Mailing Address - Phone:870-577-4388
Mailing Address - Fax:
Practice Address - Street 1:702 N MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2920
Practice Address - Country:US
Practice Address - Phone:870-340-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1911169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health