Provider Demographics
NPI:1528419819
Name:WENDY J POOLE LLC
Entity Type:Organization
Organization Name:WENDY J POOLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COACH AND COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-381-1652
Mailing Address - Street 1:475 N ELKINS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-9103
Mailing Address - Country:US
Mailing Address - Phone:479-381-1652
Mailing Address - Fax:
Practice Address - Street 1:26 E MEADOW ST STE 11
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5357
Practice Address - Country:US
Practice Address - Phone:479-381-1652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty