Healthcare Provider Details

I. General information

NPI: 1679031215
Provider Name (Legal Business Name): HOLLIE POOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2019
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 E HARRY ST STE 800
WICHITA KS
67207-5084
US

IV. Provider business mailing address

1505 COSETTE DR
DALLAS TX
75215-0002
US

V. Phone/Fax

Practice location:
  • Phone: 316-652-2590
  • Fax:
Mailing address:
  • Phone: 316-749-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number732
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2958
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number203778
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: