Provider Demographics
NPI:1841651601
Name:POOLE, CARL MICHAEL (MS, LCDC)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:MICHAEL
Last Name:POOLE
Suffix:
Gender:M
Credentials:MS, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 SHADOW CREEK PKWY APT 823
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5256
Mailing Address - Country:US
Mailing Address - Phone:281-793-1409
Mailing Address - Fax:
Practice Address - Street 1:11900 SHADOW CREEK PKWY APT 823
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5256
Practice Address - Country:US
Practice Address - Phone:281-793-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12189101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)