Provider Demographics
NPI:1083925036
Name:PUCHALSKY-SZABO, JULIANNE (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:PUCHALSKY-SZABO
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 N RANCHO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3192
Mailing Address - Country:US
Mailing Address - Phone:702-869-4300
Mailing Address - Fax:702-869-4301
Practice Address - Street 1:3670 N RANCHO DR STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3192
Practice Address - Country:US
Practice Address - Phone:702-869-4300
Practice Address - Fax:702-869-4301
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVM10181106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist