Provider Demographics
NPI:1083356182
Name:JOSEPH PAK, MARRIAGE AND FAMILY THERAPIST - LLC
Entity Type:Organization
Organization Name:JOSEPH PAK, MARRIAGE AND FAMILY THERAPIST - LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:702-981-5921
Mailing Address - Street 1:311 S FRONTAGE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4684
Mailing Address - Country:US
Mailing Address - Phone:702-981-5921
Mailing Address - Fax:
Practice Address - Street 1:311 S FRONTAGE RD STE 106
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4684
Practice Address - Country:US
Practice Address - Phone:702-981-5921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)