Provider Demographics
NPI:1003939034
Name:PIONEER HUMAN SERVICES
Entity Type:Organization
Organization Name:PIONEER HUMAN SERVICES
Other - Org Name:PIONEER COUNSELING TACOMA - FAWCETT CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT, TREATMENT & REENTRY
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-766-7018
Mailing Address - Street 1:7440 W. MARGINAL WAY S.
Mailing Address - Street 2:PIONEER HUMAN SERVICES - CONTRACTS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4141
Mailing Address - Country:US
Mailing Address - Phone:206-768-1990
Mailing Address - Fax:206-768-8910
Practice Address - Street 1:1111 FAWCETT AVE STE 200
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2024
Practice Address - Country:US
Practice Address - Phone:253-274-0484
Practice Address - Fax:253-274-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27114000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1995091Medicaid