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General NPI Number Information
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NPI Number | 1013588185
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Entity Type | Organization
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Legal Business Name | PRAIRIE COUNSELING PLLC
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 20469 KENILWORTH RD
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City | LOMA
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State | MT
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Zip | 59460-7716
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Country | US
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Telephone | 406-270-7372
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Fax | 406-219-3369
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Provider Business Mailing Address
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Address Line | 20469 KENILWORTH RD
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City | LOMA
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State | MT
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Zip | 59460-7716
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Country | US
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Telephone | 406-270-7372
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Fax | 406-219-3369
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Authorized Official
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Title or Position | PROVIDER
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Name | DIANNA KEANE
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Credential | LCPC
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Telephone | 406-270-7372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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