Provider Demographics
NPI:1063205219
Name:POWELL, MAUREEN PATRICIA
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:PATRICIA
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1329
Mailing Address - Country:US
Mailing Address - Phone:773-573-6210
Mailing Address - Fax:
Practice Address - Street 1:SMART LOVE FAMILY SERVICES
Practice Address - Street 2:1010 LAKE STREET , SUITE 500
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:773-573-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional