Provider Demographics
NPI:1336412097
Name:FAKALATA, JL SATEKI
Entity Type:Individual
Prefix:MR
First Name:JL
Middle Name:SATEKI
Last Name:FAKALATA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JL
Other - Middle Name:SATEKI
Other - Last Name:FAKALATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3481 E SUNSET RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-6207
Mailing Address - Country:US
Mailing Address - Phone:702-998-6264
Mailing Address - Fax:702-998-6270
Practice Address - Street 1:3481 E SUNSET RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-6207
Practice Address - Country:US
Practice Address - Phone:702-998-6264
Practice Address - Fax:702-998-6270
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176452218101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor