Provider Demographics
NPI:1730591637
Name:PACHECO, GRACIELA YASMIN (MFT)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:YASMIN
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:LILLIANE
Other - Last Name:OHIKERE (PACHECO)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:3275 SOUTH JONES BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146
Mailing Address - Country:US
Mailing Address - Phone:702-800-0684
Mailing Address - Fax:510-535-4167
Practice Address - Street 1:3275 SOUTH JONES BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-800-0684
Practice Address - Fax:510-535-4167
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4352-R106H00000X
CA90751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist