Basic Information
| Provider Information | |||||||||
| NPI: | 1730269010 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POOLE | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 DONS WAY | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016205130 | ||||||||
| FaxNumber: | 5016205109 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 N 26TH ST | ||||||||
| Address2: | |||||||||
| City: | ARKADELPHIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719234336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702464123 | ||||||||
| FaxNumber: | 5016205109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1771-C | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 116399726 | 05 | AR | MEDICAID | 1070032 | 01 | AR | USA MANAGED CARE | OTHER | 2325123 | 01 | AR | CIGNA BEHAVIORAL HEALTH | OTHER | 710401764POO | 01 | AR | UNITY MANAGED HEALTH CARE | OTHER | 06110016300 | 01 | AR | QUAL CHOICE | OTHER | 1730269010 | 01 | AR | VALUE OPTIONS | OTHER | 389961 | 01 | AR | MHN NETWORK | OTHER | 71-0401764 | 01 | AR | CORPHEALTH | OTHER | 710401764 | 01 | ARK COMMUNITY CARE | OTHER | 710401764 | 01 | AR | CORP HEALTH | OTHER | 710401764 | 01 | AR | NOVASYS | OTHER | 5A054 | 01 | AR | BLUE CROSS & BLUE SHIELD | OTHER |