Provider Demographics
NPI:1598381055
Name:POORE, DELANA ANN (LPC)
Entity type:Individual
Prefix:
First Name:DELANA
Middle Name:ANN
Last Name:POORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DELANA
Other - Middle Name:ANN
Other - Last Name:MUNSTERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2822 W LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8705
Mailing Address - Country:US
Mailing Address - Phone:417-368-1464
Mailing Address - Fax:
Practice Address - Street 1:106 W 4TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1402
Practice Address - Country:US
Practice Address - Phone:660-207-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-21
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020017544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional