Provider Demographics
NPI:1083163117
Name:POOL, GERALYN JERNELLE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:GERALYN
Middle Name:JERNELLE
Last Name:POOL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 LAMAR LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-7387
Mailing Address - Country:US
Mailing Address - Phone:504-234-0820
Mailing Address - Fax:
Practice Address - Street 1:1330 LAMAR LN
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-7387
Practice Address - Country:US
Practice Address - Phone:504-234-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional