Provider Demographics
NPI:1194273391
Name:PASCUAL, RYANJACOB (MS, LPC-I)
Entity type:Individual
Prefix:MR
First Name:RYANJACOB
Middle Name:
Last Name:PASCUAL
Suffix:
Gender:M
Credentials:MS, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6871 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1600
Mailing Address - Country:US
Mailing Address - Phone:702-489-2117
Mailing Address - Fax:702-467-4767
Practice Address - Street 1:6871 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1600
Practice Address - Country:US
Practice Address - Phone:702-489-2117
Practice Address - Fax:702-467-4767
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI2794101YP2500X, 101YP2500X
NVRBT1001106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1760886881Medicaid