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NPI Code Detail

MEDICARE: MARIA PENNYWELL

MEDICARE: MARIA PENNYWELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1497298863
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA PENNYWELL
Provider Business Mailing Address
First Line : 506 HIGHWAY 2
Second Line :
City : STERLINGTON
State : LA
Zip : 71280-3004
Country : US
Telephone Number : 331-859-8504
Fax Number :
Provider Business Practice Location Address
First Line : 506 HIGHWAY 2
Second Line :
City : STERLINGTON
State : LA
Zip : 71280-3004
Country : US
Telephone Number : 331-859-8504
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2016
Last Update Date : 12/02/2016

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Directions to “ MARIA PENNYWELL ” Practice Location

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