Provider Demographics
NPI:1124572615
Name:POGUE LLC
Entity type:Organization
Organization Name:POGUE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:POGUE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-286-6157
Mailing Address - Street 1:PO BOX 20592
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7013
Mailing Address - Country:US
Mailing Address - Phone:307-286-6157
Mailing Address - Fax:307-632-2346
Practice Address - Street 1:5815 DAKOTA DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-8543
Practice Address - Country:US
Practice Address - Phone:307-286-6157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1247101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty