Provider Demographics
NPI:1497012413
Name:POOLE-MCLAIN, JANA MARIE
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:MARIE
Last Name:POOLE-MCLAIN
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 1:22302 RUSTIC BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3915
Mailing Address - Country:US
Mailing Address - Phone:832-971-5262
Mailing Address - Fax:
Practice Address - Street 1:22302 RUSTIC BRIDGE LN
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3915
Practice Address - Country:US
Practice Address - Phone:832-971-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-15
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional