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General NPI Number Information
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NPI Number | 1457156630
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Entity Type | Individual
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Provider Name | BAILEY AARON PENNER LMLP-T
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Gender | Male
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 900 N POPLAR ST
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City | NEWTON
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State | KS
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Zip | 67114-1956
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Country | US
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Telephone | 316-803-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 725 OLD-MILL RD
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City | PEABODY
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State | KS
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Zip | 66866-9401
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Country | US
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Telephone | 620-983-9023
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 03388-T
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License Number State | KS
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