Provider Demographics
NPI:1518206465
Name:ACTION LIFE SERVICES, LLC
Entity Type:Organization
Organization Name:ACTION LIFE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILSON-HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-217-2141
Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1066
Mailing Address - Country:US
Mailing Address - Phone:307-217-2414
Mailing Address - Fax:
Practice Address - Street 1:963 FORT ST
Practice Address - Street 2:#4
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-2424
Practice Address - Country:US
Practice Address - Phone:307-217-2414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty