Doctor Name: | DR. DONALD ROY PAKE |
NPI Number: | 1417140542 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | MH6513 |
Business Practice Address: | 429 S Tyndall Pkwy Ste B Callaway, FL - 324046746 |
Business Phone Number: | 8505413504 |
Business Fax Number: | 8507856700 |
Mailing Address: | 429 S Tyndall Pkwy Ste B, CALLAWAY |
State: | FL |
Postal Code: | 324046746 |
Phone Number: | 8505413504 |
Fax Number: | 8507856700 |
NPI Enumeration Date: | 08/22/2007 |
NPI Last Update Date: | 08/22/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH6513 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |