Kristin Poole

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-1968 Issued in WY

Practice address

640 E Broadway Ave
Jackson, WY 83001-8642

Phone

(307) 733-2046

Fax

(307) 733-6289

NPI assigned

Jun 21, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Health & Recovery Services of Jackson Hole

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jackson, WY
  • NPI 1578635462
  Medicare reassignment NPD
• Inner Balance Therapy, LLC

  • Adult Mental Health Clinic/Center
  • Jackson, WY
  • NPI 1912744301
  NPD Authorized official
• Mental Health & Recovery Services of Jackson Hole

  • Case Manager/Care Coordinator
  • Jackson, WY
  • NPI 1548137508
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1982273298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1868",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830011868",
            "telephone_number": "307-733-2046",
            "fax_number": "307-733-6289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018642",
            "telephone_number": "307-733-2046",
            "fax_number": "307-733-6289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "KRISTIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-21",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WY",
            "license": "LPC-1968",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WY",
            "license": "PPC-1110",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Lawrence Pfeifer, SA-C
• Vita Picchi, LAC
• Amy Pitman, L.C.S.W.
• Thomas J Pockat, M.D.
• Mark B Pommer, ED.M
• P George Poore, MD
• Gary Post, MSW
• Lisa Marie Potzernitz
• Brian Charles Prax, MA PT
• Madison Prescott, RBT

• Professional Counselor in Jackson, WY
• Providers in Jackson, WY by specialty
• Professional Counselor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.