Provider Demographics
NPI:1831395276
Name:JOHN S. PACULT, LCSW, INC.
Entity type:Organization
Organization Name:JOHN S. PACULT, LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SEBASTIAN
Authorized Official - Last Name:PACULT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:702-248-5456
Mailing Address - Street 1:2980 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6531
Mailing Address - Country:US
Mailing Address - Phone:702-248-5456
Mailing Address - Fax:702-889-4232
Practice Address - Street 1:2980 S RAINBOW BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6531
Practice Address - Country:US
Practice Address - Phone:702-248-5456
Practice Address - Fax:702-889-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health