| Doctor Name: | RICK E. POULIN |
| NPI Number: | 1205014933 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LISAC |
| License Number: | LISAC-10549 |
| Business Practice Address: | 483 W. Seed Farm Rd. New Beginnings Building Sacaton, AZ - 852470038 |
| Business Phone Number: | 6025287164 |
| Business Fax Number: | 6025281374 |
| Mailing Address: | 483 W. Seed Farm Rd., New Beginnings Building SACATON |
| State: | AZ |
| Postal Code: | 852470038 |
| Phone Number: | 6025287164 |
| Fax Number: | 6025281374 |
| NPI Enumeration Date: | 02/05/2008 |
| NPI Last Update Date: | 02/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LISAC-10549 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |