Provider Demographics
NPI:1487984944
Name:POOLE, ANTHONY ALLEN SR (MPA, MAC, CCJS)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ALLEN
Last Name:POOLE
Suffix:SR
Gender:M
Credentials:MPA, MAC, CCJS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HOLIDAY INN PLAZA
Mailing Address - Street 2:SUITE 400, ILLINOIS MENTOR
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2241
Mailing Address - Country:US
Mailing Address - Phone:708-679-9137
Mailing Address - Fax:
Practice Address - Street 1:600 HOLIDAY INN PLAZA
Practice Address - Street 2:SUITE 400, ILLINOIS MENTOR
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2241
Practice Address - Country:US
Practice Address - Phone:708-679-9137
Practice Address - Fax:708-679-6861
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor