Healthcare Provider Details

I. General information

NPI: 1346616380
Provider Name (Legal Business Name): CHRISTY PENNISON LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 RUE VERDUN STE A
ALEXANDRIA LA
71303-2578
US

IV. Provider business mailing address

3312 KALISTE SALOOM RD
LAFAYETTE LA
70508-7449
US

V. Phone/Fax

Practice location:
  • Phone: 318-266-7021
  • Fax:
Mailing address:
  • Phone: 337-237-0788
  • Fax: 337-237-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5216
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5216
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: