Healthcare Provider Details

I. General information

NPI: 1295465375
Provider Name (Legal Business Name): TERESA PENNINGTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S GREELEY HWY STE B
CHEYENNE WY
82007-3063
US

IV. Provider business mailing address

1217 S GREELEY HWY STE B
CHEYENNE WY
82007-3063
US

V. Phone/Fax

Practice location:
  • Phone: 307-202-4005
  • Fax: 307-200-0218
Mailing address:
  • Phone: 307-202-4005
  • Fax: 307-200-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC1089
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: