Provider Demographics
NPI:1730394966
Name:POOLE, CLAIRE C (PSYD)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:C
Last Name:POOLE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 E FLORIDA AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2571
Mailing Address - Country:US
Mailing Address - Phone:303-782-0252
Mailing Address - Fax:
Practice Address - Street 1:3801 E FLORIDA AVE
Practice Address - Street 2:STE 700
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2571
Practice Address - Country:US
Practice Address - Phone:303-782-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07106149Medicaid