Provider Demographics
NPI:1275762270
Name:POIRE, KORTNEY M (TLPC)
Entity Type:Individual
Prefix:MRS
First Name:KORTNEY
Middle Name:M
Last Name:POIRE
Suffix:
Gender:F
Credentials:TLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 W 7TH ST
Mailing Address - Street 2:PO BOX 512
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-2505
Mailing Address - Country:US
Mailing Address - Phone:620-432-5200
Mailing Address - Fax:620-432-5222
Practice Address - Street 1:1709 W 7TH ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-2505
Practice Address - Country:US
Practice Address - Phone:620-432-5200
Practice Address - Fax:620-432-5222
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LPC2097101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor