Provider Demographics
NPI:1205112125
Name:POOLE, LINDA FAYE (LPC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:FAYE
Last Name:POOLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19901 COAST REDWOOD AVE
Mailing Address - Street 2:APT G242
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-8182
Mailing Address - Country:US
Mailing Address - Phone:541-806-1592
Mailing Address - Fax:
Practice Address - Street 1:19901 COAST REDWOOD AVE
Practice Address - Street 2:APT G242
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-8182
Practice Address - Country:US
Practice Address - Phone:541-806-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2612101YP2500X
OR810272101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool