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NPI Code Detail

MEDICARE: PREMIER COUNSELING SERVICES, LLC

MEDICARE: PREMIER COUNSELING SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor1139NE

General Provider Information

NPI Number : 1205227394
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER COUNSELING SERVICES, LLC
Provider Business Mailing Address
First Line : 3421 MACOMB AVE
Second Line :
City : SIOUX CITY
State : IA
Zip : 51106-1626
Country : US
Telephone Number : 712-870-1445
Fax Number :
Provider Business Practice Location Address
First Line : 625 E 39TH ST
Second Line :
City : SOUTH SIOUX CITY
State : NE
Zip : 68776-3445
Country : US
Telephone Number : 712-870-1445
Fax Number :
Authorized Official
Title or Position : CLINICAL THERAPIST
Name : KELLEY POLK
Credential : LIMHP, LADC
Telephone Number : 712-870-1445
Provider Enumeration Date : 02/10/2015
Last Update Date : 02/10/2015

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Directions to “PREMIER COUNSELING SERVICES, LLC ” Practice Location

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