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3519 E Walnut St Unit 422 Pearland TX 77588-0858 | |
| (678) 310-7564 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3519 E Walnut St Unit 422, Pearland, Texas |
| Authorized Official Name and Position | Cherice Poole (OWNER/THERAPIST) |
| Authorized Official Contact | 6783107564 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3519 E Walnut St Unit 422 Pearland TX 77588-0858 Ph: (678) 310-7564 | 3519 E Walnut St Unit 422 Pearland TX 77588-0858 Ph: (678) 310-7564 |
| NPI Number | 1700362050 |
|---|---|
| Provider Enumeration Date | 07/18/2018 |
| Last Update Date | 05/06/2024 |
| Certification Date | 05/06/2024 |
| Medicare PECOS PAC ID | 5092186031 |
|---|---|
| Medicare Enrollment ID | O20230130001376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700362050 | NPI | - | NPPES |
| 1518377266 | Other | GA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Cherice Poole |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518377266 PECOS PAC ID: 0941511414 Enrollment ID: I20230130001755 |
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