Provider Demographics
NPI:1912616806
Name:PAK, SOO MI (LPCC0018856)
Entity Type:Individual
Prefix:
First Name:SOO
Middle Name:MI
Last Name:PAK
Suffix:
Gender:F
Credentials:LPCC0018856
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 N GENOA WAY APT 14-306
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80019-2089
Mailing Address - Country:US
Mailing Address - Phone:720-788-1821
Mailing Address - Fax:
Practice Address - Street 1:5755 N GENOA WAY APT 14-306
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80019-2089
Practice Address - Country:US
Practice Address - Phone:720-788-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0018856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional