Provider Demographics
NPI:1891022539
Name:PIONEER
Entity Type:Organization
Organization Name:PIONEER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CLOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:405-615-9267
Mailing Address - Street 1:RR 2 BOX 225
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:OK
Mailing Address - Zip Code:74855-9629
Mailing Address - Country:US
Mailing Address - Phone:405-615-9267
Mailing Address - Fax:405-279-2773
Practice Address - Street 1:23 E 9TH ST
Practice Address - Street 2:SUITE 444
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6943
Practice Address - Country:US
Practice Address - Phone:405-615-9267
Practice Address - Fax:405-279-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health