MEDICARE: JOHN S. PACULT, LCSW, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1831395276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN S. PACULT, LCSW, INC.

Provider Business Mailing Address
First Line	:	2980 S RAINBOW BLVD
Second Line	:	SUITE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6531
Country	:	US
Telephone Number	:	702-248-5456
Fax Number	:	702-889-4232

Provider Business Practice Location Address
First Line	:	2980 S RAINBOW BLVD
Second Line	:	SUITE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6531
Country	:	US
Telephone Number	:	702-248-5456
Fax Number	:	702-889-4232

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. JOHN SEBASTIAN PACULT
Credential	:	MSW, LCSW
Telephone Number	:	702-248-5456

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	08/19/2008

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