Provider Demographics
NPI:1740514405
Name:POOT, JASON D (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:D
Last Name:POOT
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4382
Mailing Address - Country:US
Mailing Address - Phone:307-265-3977
Mailing Address - Fax:307-265-3038
Practice Address - Street 1:5725 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4382
Practice Address - Country:US
Practice Address - Phone:307-265-3977
Practice Address - Fax:307-265-3038
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional