Kristin Poole, | |
640 E Broadway Ave, Jackson, WY 83001-8642 | |
(307) 733-2046 | |
(307) 733-6289 |
Full Name | Kristin Poole |
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Gender | Female |
Speciality | Counselor - Professional |
Location | 640 E Broadway Ave, Jackson, Wyoming |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1982273298 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | LPC-1968 (Wyoming) | Primary |
101YP2500X | Counselor - Professional | PPC-1110 (Wyoming) | Secondary |
Entity Name | Mental Health & Recovery Services Of Jackson Hole |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1578635462 PECOS PAC ID: 0840272472 Enrollment ID: O20040607000292 |
Mailing Address | Practice Location Address |
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Kristin Poole, Po Box 1868, Jackson, WY 83001-1868 Ph: (307) 733-2046 | Kristin Poole, 640 E Broadway Ave, Jackson, WY 83001-8642 Ph: (307) 733-2046 |
Lorraine Thompson, LPC, NCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 125 E Pearl Ave Ste B005, Jackson, WY 83001 Phone: 307-699-5025 | |
Starr Marie Sonne, M.ED.; LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 145 E Snow King Ave, Office #3, Jackson, WY 83001 Phone: 307-699-1329 | |
Sandra Sanderson, ED.S Counselor Medicare: Not Enrolled in Medicare Practice Location: 140 E Broadway Ave # 13, Jackson, WY 83001 Phone: 307-413-6528 | |
Tracy Hiatt, ED.S. PPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 125 E Pearl Ave Ste B005, Jackson, WY 83001 Phone: 307-264-0161 | |
Leann M. Dzemske, M. SC., LPC, ATR Counselor Medicare: Medicare Enrolled Practice Location: 690 S Hwy 89 # 201, Jackson, WY 83001 Phone: 307-231-2001 Fax: 307-288-6056 | |
Margaret Brigham, PPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 510 S Cache St, Jackson, WY 83001 Phone: 307-733-6440 | |
Ms. Cheryl Ann Renzulli, MA, LAT Counselor Medicare: Not Enrolled in Medicare Practice Location: 1115 Maple Way, Suite C, Jackson, WY 83001 Phone: 307-699-0807 Fax: 307-733-7339 |