Basic Information
| Provider Information | |||||||||
| NPI: | 1710252606 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAK | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | SUNIL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 BOURBON ST # G1 | ||||||||
| Address2: | |||||||||
| City: | PAHRUMP | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890486191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029810735 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1050 E FLAMINGO RD STE E-120 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891197427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027338098 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2012 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 3214 | NV | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.