Provider Demographics
NPI:1952680001
Name:PAKT, LLC
Entity Type:Organization
Organization Name:PAKT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AS, MEMBER OF PAKT, LLC
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNT-GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:765-210-0881
Mailing Address - Street 1:PO BOX 3710
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47996-3710
Mailing Address - Country:US
Mailing Address - Phone:765-210-0881
Mailing Address - Fax:
Practice Address - Street 1:133 N 4TH ST
Practice Address - Street 2:SUITE 511
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1371
Practice Address - Country:US
Practice Address - Phone:765-210-0881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health