Provider Demographics
NPI:1760281331
Name:PIMENTEL ANTON, JOAQUIN (LMLP)
Entity type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:
Last Name:PIMENTEL ANTON
Suffix:
Gender:
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 N SANDPLUM ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-2073
Mailing Address - Country:US
Mailing Address - Phone:316-205-5737
Mailing Address - Fax:
Practice Address - Street 1:659 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3515
Practice Address - Country:US
Practice Address - Phone:316-201-6294
Practice Address - Fax:316-364-3020
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03405103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty