Provider Demographics
NPI:1013588185
Name:PRAIRIE COUNSELING PLLC
Entity Type:Organization
Organization Name:PRAIRIE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-270-7372
Mailing Address - Street 1:20469 KENILWORTH RD
Mailing Address - Street 2:
Mailing Address - City:LOMA
Mailing Address - State:MT
Mailing Address - Zip Code:59460-7716
Mailing Address - Country:US
Mailing Address - Phone:406-270-7372
Mailing Address - Fax:406-219-3369
Practice Address - Street 1:20469 KENILWORTH RD
Practice Address - Street 2:
Practice Address - City:LOMA
Practice Address - State:MT
Practice Address - Zip Code:59460-7716
Practice Address - Country:US
Practice Address - Phone:406-270-7372
Practice Address - Fax:406-219-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1003051046Medicaid