=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992344063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIONEER COUNSELING AND WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2020
-----------------------------------------------------
Last Update Date | 01/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 730 N MONTANA ST STE 11
-----------------------------------------------------
City | DILLON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59725-8497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-988-0980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1261
-----------------------------------------------------
City | DILLON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59725-1261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | HEIDI GJEFLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-988-0980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------