Basic Information
| Provider Information | |||||||||
| NPI: | 1184923138 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PACIFIC ASIAN COUNSELING SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3530 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908074569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624241886 | ||||||||
| FaxNumber: | 5624242296 | ||||||||
| Practice Location | |||||||||
| Address1: | 3530 ATLANTIC AVE. ST. 210 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624241886 | ||||||||
| FaxNumber: | 5624242296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2011 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | KANN | ||||||||
| AuthorizedOfficialFirstName: | SOVUTH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CASE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5624241886 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.