Provider Demographics
NPI:1962136176
Name:POOLE, DONALD II (LSAA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:POOLE
Suffix:II
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 W ARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8513
Mailing Address - Country:US
Mailing Address - Phone:505-564-3733
Mailing Address - Fax:
Practice Address - Street 1:653 W ARRINGTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8513
Practice Address - Country:US
Practice Address - Phone:505-564-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0241101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCTB20220241OtherCOUNSELING AND THERAPY PRACTICE BOARD