# P.R.I.M.E EXECUTIVE HOLDING GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881514750
- **Authorized official:** MRS. VIRGINA POUGH MA (COMPLIANCE & QUALITY DIRECTOR)
- **Authorized official phone:** (307) 285-0360

## Contact information

- **Practice address:** 309 MUNICIPAL DR, THORNDALE, PA 19372-1023
- **Practice address phone:** (307) 285-0358
- **Practice address fax:** (307) 285-0358
- **Mailing address:** 30 N GOULD ST \# 65891, SHERIDAN, WY 82801-6317
- **Mailing address phone:** (307) 285-0358
- **Mailing address fax:** (307) 285-0358

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 07/20/2026
- **Last updated:** 07/20/2026