Provider Demographics
NPI:1558042218
Name:PLEASANT PLACE PSYCHIATRY PLLC
Entity type:Organization
Organization Name:PLEASANT PLACE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDIOMI
Authorized Official - Middle Name:E
Authorized Official - Last Name:ENEBONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-206-1265
Mailing Address - Street 1:4925 S BROADWAY AVE # 1077
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-3716
Mailing Address - Country:US
Mailing Address - Phone:507-353-2419
Mailing Address - Fax:507-607-8967
Practice Address - Street 1:6611 E CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1937
Practice Address - Country:US
Practice Address - Phone:507-353-2419
Practice Address - Fax:507-607-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty