Provider Demographics
NPI:1639965874
Name:POOLE, TALIA JOHN
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:JOHN
Last Name:POOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 E THORNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6826
Mailing Address - Country:US
Mailing Address - Phone:208-705-5655
Mailing Address - Fax:
Practice Address - Street 1:1218 W SOUTH JORDAN PKWY STE A2
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5946
Practice Address - Country:US
Practice Address - Phone:385-645-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist