MEDICARE: PATRICIA PENNINGTON

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1609300011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA PENNINGTON

Provider Business Mailing Address
First Line	:	9708 GILESPIE ST
Second Line	:	ATE 114
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7613
Country	:	US
Telephone Number	:	702-351-0502
Fax Number	:

Provider Business Practice Location Address
First Line	:	9708 GILESPIE ST
Second Line	:	ATE 114
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7613
Country	:	US
Telephone Number	:	702-351-0502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2017
Last Update Date	:	04/13/2017

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Directions to “ PATRICIA PENNINGTON ” Practice Location

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