Provider Demographics
NPI:1255845939
Name:POOT COUNSELING, LLC
Entity Type:Organization
Organization Name:POOT COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:POOT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-421-2520
Mailing Address - Street 1:1286 W LEISURE DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8834
Mailing Address - Country:US
Mailing Address - Phone:360-421-2520
Mailing Address - Fax:
Practice Address - Street 1:1286 W LEISURE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8834
Practice Address - Country:US
Practice Address - Phone:360-421-2520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005703101YP2500X
261QM0801X
WAAP30006966363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013912385OtherNPI