Provider Demographics
NPI:1902267883
Name:PIONEER FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:PIONEER FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:PEHRSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-823-9042
Mailing Address - Street 1:5550 W FLAMINGO RD STE D2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-0138
Mailing Address - Country:US
Mailing Address - Phone:702-984-1192
Mailing Address - Fax:702-485-1107
Practice Address - Street 1:5550 W FLAMINGO RD STE D2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-0138
Practice Address - Country:US
Practice Address - Phone:702-984-1192
Practice Address - Fax:702-485-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161139243251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health