Provider Demographics
NPI:1184708190
Name:POORE, KEVEN MARK (LPC, DCC)
Entity type:Individual
Prefix:MR
First Name:KEVEN
Middle Name:MARK
Last Name:POORE
Suffix:
Gender:M
Credentials:LPC, DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-3712
Mailing Address - Country:US
Mailing Address - Phone:215-346-7137
Mailing Address - Fax:215-657-8974
Practice Address - Street 1:137 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-3712
Practice Address - Country:US
Practice Address - Phone:215-346-7137
Practice Address - Fax:215-657-8974
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC004965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)