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General NPI Number Information
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NPI Number | 1952680001
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Entity Type | Organization
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Legal Business Name | PAKT, LLC
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 133 N 4TH ST SUITE 511
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City | LAFAYETTE
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State | IN
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Zip | 47901-1371
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Country | US
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Telephone | 765-210-0881
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3710
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City | WEST LAFAYETTE
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State | IN
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Zip | 47996-3710
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Country | US
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Telephone | 765-210-0881
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Fax |
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Authorized Official
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Title or Position | AS, MEMBER OF PAKT, LLC
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Name | GINGER L HUNT-GOINS
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Credential | MSW, LSW
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Telephone | 765-210-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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