Provider Demographics
NPI:1780695445
Name:POOT, ARIE (MDIV, MA)
Entity type:Individual
Prefix:MR
First Name:ARIE
Middle Name:
Last Name:POOT
Suffix:
Gender:M
Credentials:MDIV, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17091 SOCKEYE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-9156
Mailing Address - Country:US
Mailing Address - Phone:360-421-2436
Mailing Address - Fax:360-336-2521
Practice Address - Street 1:117 N 1ST ST
Practice Address - Street 2:SUITE 55
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2859
Practice Address - Country:US
Practice Address - Phone:360-421-2436
Practice Address - Fax:360-336-2521
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health