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NPI Code Detail

MEDICARE: MRS. MARSHA BETH POORE

MEDICARE: MRS. MARSHA BETH POORE
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1194398271
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARSHA BETH POORE
Provider Business Mailing Address
First Line : 606 E SPRING ST STE B
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-5067
Country : US
Telephone Number : 931-303-0665
Fax Number : 931-303-0667
Provider Business Practice Location Address
First Line : 606 E SPRING ST STE B
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-5067
Country : US
Telephone Number : 931-303-0665
Fax Number : 931-303-0667
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2021
Last Update Date : 07/19/2021

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