| Doctor Name: | MR. KEVEN MARK POORE |
| NPI Number: | 1184708190 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, DCC |
| License Number: | |
| Business Practice Address: | 137 Brentwood Dr Willow Grove, PA - 190903712 |
| Business Phone Number: | 2153467137 |
| Business Fax Number: | 2156578974 |
| Mailing Address: | 137 Brentwood Dr, WILLOW GROVE |
| State: | PA |
| Postal Code: | 190903712 |
| Phone Number: | 2153467137 |
| Fax Number: | 2156578974 |
| NPI Enumeration Date: | 10/25/2006 |
| NPI Last Update Date: | 03/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |