| Doctor Name: | RANDALL H POWELL |
| NPI Number: | 1104190081 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BA, MHP |
| License Number: | |
| Business Practice Address: | 1412 Us Highway 45 N Eldorado, IL - 629303766 |
| Business Phone Number: | 6182733326 |
| Business Fax Number: | 6182732808 |
| Mailing Address: | 1412 Us Highway 45 N, ELDORADO |
| State: | IL |
| Postal Code: | 629303766 |
| Phone Number: | 6182733326 |
| Fax Number: | 6182732808 |
| NPI Enumeration Date: | 02/24/2012 |
| NPI Last Update Date: | 02/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |