Healthcare Provider Details

I. General information

NPI: 1508140708
Provider Name (Legal Business Name): SONYA PARKER POOLE LPC NCC NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 JENKINS ST
MANSFIELD LA
71052-3128
US

IV. Provider business mailing address

702 BETHEL RD
LOGANSPORT LA
71049-2346
US

V. Phone/Fax

Practice location:
  • Phone: 318-469-1556
  • Fax:
Mailing address:
  • Phone: 318-469-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberAN576528
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4230
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: