MEDICARE: MS. PATRICIA ANN POOLE CRSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1164791984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA ANN POOLE CRSS

Provider Business Mailing Address
First Line	:	8712 E MAIN ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8712 E MAIN ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7706
Country	:	US
Telephone Number	:	405-313-2656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	12/22/2011

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