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General NPI Number Information
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NPI Number | 1881514750
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Entity Type | Organization
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Legal Business Name | P.R.I.M.E EXECUTIVE HOLDING GROUP LLC
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 309 MUNICIPAL DR
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City | THORNDALE
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State | PA
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Zip | 19372-1023
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Country | US
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Telephone | 307-285-0358
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Fax | 307-285-0358
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Provider Business Mailing Address
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Address Line | 30 N GOULD ST # 65891
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 307-285-0358
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Fax | 307-285-0358
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Authorized Official
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Title or Position | COMPLIANCE & QUALITY DIRECTOR
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Name | MRS. VIRGINA POUGH
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Credential | MA
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Telephone | 307-285-0360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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