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General NPI Number Information
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NPI Number | 1073054987
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Entity Type | Individual
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Provider Name | MISS JOSLYN PENNYWELL
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Gender | Female
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 15021 VENTURA BLVD STE 332
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2442
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Country | US
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Telephone | 818-570-0337
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Fax |
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Provider Business Mailing Address
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Address Line | 6940 SEPULVEDA BLVD APT 105
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City | VAN NUYS
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State | CA
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Zip | 91405-5427
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Country | US
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Telephone | 318-548-5048
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 008331360
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License Number State | LA
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