Provider Demographics
NPI:1548409667
Name:PIONEER COUNSELING SERVICES
Entity Type:Organization
Organization Name:PIONEER COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-789-7915
Mailing Address - Street 1:350 CITY VIEW DR
Mailing Address - Street 2:STE 302
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5327
Mailing Address - Country:US
Mailing Address - Phone:307-789-7915
Mailing Address - Fax:307-789-6009
Practice Address - Street 1:350 CITY VIEW DR
Practice Address - Street 2:STE 302
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5327
Practice Address - Country:US
Practice Address - Phone:307-789-7915
Practice Address - Fax:307-789-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY008500251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106662500Medicaid