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General NPI Number Information
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NPI Number | 1922403476
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Entity Type | Organization
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Legal Business Name | PENNER COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 101 E 1ST AVE
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City | HUTCHINSON
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State | KS
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Zip | 67501-7147
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Country | US
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Telephone | 620-200-4800
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Fax | 620-662-5621
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Provider Business Mailing Address
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Address Line | PO BOX 772
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City | HUTCHINSON
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State | KS
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Zip | 67504-0772
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Country | US
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Telephone | 620-200-4800
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Fax | 620-662-5621
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | MATTHEW L. PENNER
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Credential | MSW, LSCSW, LCAC
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Telephone | 620-200-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4227
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License Number State | KS
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