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General NPI Number Information
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NPI Number | 1053723551
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Entity Type | Organization
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Legal Business Name | COUNSELING BY PENNY
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 1104 MALLARD WAY
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City | GRANBURY
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State | TX
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Zip | 76048-2674
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Country | US
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Telephone | 817-657-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 MALLARD WAY
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City | GRANBURY
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State | TX
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Zip | 76048-2674
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Country | US
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Telephone | 817-657-1115
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PENNY HAIGHT
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Credential | MED..LPC-S
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Telephone | 817-657-1115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 63788
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License Number State | TX
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