Provider Demographics
NPI:1568129856
Name:PIMENTEL, MONICA DEL SOCORRO
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:DEL SOCORRO
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 HARVARD AVE APT 2105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3739
Mailing Address - Country:US
Mailing Address - Phone:214-616-1770
Mailing Address - Fax:
Practice Address - Street 1:4054 MCKINNEY AVE STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2059
Practice Address - Country:US
Practice Address - Phone:214-616-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79342101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty