Provider Demographics
NPI:1245634518
Name:POOL, JENNIE (CMHC)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:POOL
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N 200 W STE 2
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-1303
Mailing Address - Country:US
Mailing Address - Phone:435-705-9213
Mailing Address - Fax:
Practice Address - Street 1:55 N 200 W STE 2
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-1303
Practice Address - Country:US
Practice Address - Phone:435-705-9213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9526241-6004101YM0800X
UT952624-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health