Active NPI
Mark Powless, PH.D.
- Clinical Psychologist
- Milwaukee, WI
National Provider Identifier
1780969238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2967-57
- Practice address
- 1711 S 11TH St
Milwaukee, WI 53204-3310 - Phone
- (414) 383-9526
- Fax
- (414) 469-2719
- NPI assigned
- Oct 17, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 380260 | WI | |
| Clinical Psychologist | 103TC0700X | 2967-57 | WI | Primary |
Addresses
Primary practice location
1711 S 11TH St
Milwaukee, WI 53204-3310
Mailing address
6850 South Dory Drive
Franklin, WI 53132
Phone (414) 828-1645
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 380260 | WI | MD | Psychologist |
| 2967-57 | WI | MD | Clinical Psychologist |
| 2967 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410220800000",
"number": "1780969238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6850 SOUTH DORY DRIVE",
"city": "FRANKLIN",
"state": "WI",
"postal_code": "53132",
"telephone_number": "414-828-1645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1711 S 11TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532043310",
"telephone_number": "414-383-9526",
"fax_number": "414-469-2719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWLESS",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-17",
"last_updated": "2014-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "380260",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "2967-57",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.