Healthcare Provider Details

I. General information

NPI: 1043227861
Provider Name (Legal Business Name): LINDA MARIE PENNINGTON LPC, MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SOUTH 31ST SUITE #303
TEMPLE TX
76504
US

IV. Provider business mailing address

1010 W JASPER DR STE 9
KILLEEN TX
76542-1328
US

V. Phone/Fax

Practice location:
  • Phone: 877-519-1144
  • Fax: 254-519-1155
Mailing address:
  • Phone: 254-519-1144
  • Fax: 254-519-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5449
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: