Provider Demographics
NPI:1396957775
Name:POOLE, CAROLYN (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 PIONEER TRL
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3313
Mailing Address - Country:US
Mailing Address - Phone:512-327-2272
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:BLDG. 3, SUITE 301
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-327-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional