Provider Demographics
NPI:1710238068
Name:POOL, JAMES LANCE
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LANCE
Last Name:POOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:TRACY CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37387-0267
Mailing Address - Country:US
Mailing Address - Phone:931-636-4694
Mailing Address - Fax:
Practice Address - Street 1:13421 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:TRACY CITY
Practice Address - State:TN
Practice Address - Zip Code:37387-5247
Practice Address - Country:US
Practice Address - Phone:931-636-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN151213101YM0800X, 101YA0400X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)