Provider Demographics
NPI:1457333965
Name:SCHMIDT, DUMONT K (LP, PHD)
Entity Type:Individual
Prefix:
First Name:DUMONT
Middle Name:K
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:LP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7570 W 21ST ST N
Mailing Address - Street 2:STE 1026D
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-729-6555
Mailing Address - Fax:316-634-4794
Practice Address - Street 1:7570 W 21ST ST N
Practice Address - Street 2:STE 1026D
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:316-729-6555
Practice Address - Fax:316-634-4794
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS497103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
060763Medicare ID - Type Unspecified