Provider Demographics
NPI:1306914239
Name:POORE, MARIE R (MFT)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:R
Last Name:POORE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 VERDUGO BLD
Mailing Address - Street 2:#260
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208
Mailing Address - Country:US
Mailing Address - Phone:818-957-8385
Mailing Address - Fax:818-790-0219
Practice Address - Street 1:1809 VERDUGO BLD
Practice Address - Street 2:#260
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208
Practice Address - Country:US
Practice Address - Phone:818-957-8385
Practice Address - Fax:818-790-0219
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT220L9106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist