Provider Demographics
NPI:1831429935
Name:POOLE, ELIZABETH JEAN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:POOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 PARTHENIA PL
Mailing Address - Street 2:4
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5166
Mailing Address - Country:US
Mailing Address - Phone:818-895-5002
Mailing Address - Fax:818-895-5502
Practice Address - Street 1:8745 PARTHENIA PL
Practice Address - Street 2:4
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5166
Practice Address - Country:US
Practice Address - Phone:818-895-5002
Practice Address - Fax:818-895-5502
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)