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General NPI Number Information
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NPI Number | 1235667601
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Entity Type | Organization
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Legal Business Name | DR GERALD W PENNIE
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 3805 22ND ST STE 1C
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City | LUBBOCK
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State | TX
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Zip | 79410-1142
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Country | US
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Telephone | 713-417-6057
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Fax | 713-417-6057
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Provider Business Mailing Address
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Address Line | 2735 GENOA AVE APT 2B
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City | LUBBOCK
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State | TX
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Zip | 79407-7848
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Country | US
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Telephone | 713-417-6057
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Fax |
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Authorized Official
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Title or Position | LEAD COUNSELOR
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Name | DR. GERALD WAYNE PENNIE
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Credential | PHD, LPC, NCC
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Telephone | 713-417-6057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 72286
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 72286
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 72286
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License Number State | TX
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