MEDICARE: DENISE D POISSON

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	390200000X	Student in an Organized Health Care Education/Training Program
2	101YP2500X	Professional Counselor	1408	CA

General Provider Information

NPI Number	:	1417143025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE D POISSON

Provider Business Mailing Address
First Line	:	22287 MULHOLLAND HWY
Second Line	:	#136
City	:	CALABASAS
State	:	CA
Zip	:	91302-5157
Country	:	US
Telephone Number	:	330-807-4509
Fax Number	:

Provider Business Practice Location Address
First Line	:	22287 MULHOLLAND HWY
Second Line	:	#136
City	:	CALABASAS
State	:	CA
Zip	:	91302-5157
Country	:	US
Telephone Number	:	330-807-4509
Fax Number	:

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	03/31/2015

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Directions to “ DENISE D POISSON ” Practice Location

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