Provider Demographics
NPI:1114384906
Name:PIMENTEL, JUAN ENO SR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ENO
Last Name:PIMENTEL
Suffix:SR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 PALENCIA DR APT 2008
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1857
Mailing Address - Country:US
Mailing Address - Phone:813-203-7174
Mailing Address - Fax:
Practice Address - Street 1:3450 PALENCIA DR APT 2008
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1857
Practice Address - Country:US
Practice Address - Phone:813-203-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health