Basic Information
| Provider Information | |||||||||
| NPI: | 1427440254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENNINGTON | ||||||||
| FirstName: | JEANNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3611 FARM TO MARKET RD | ||||||||
| Address2: | |||||||||
| City: | NEW EDINBURG | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703131366 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 N CLIFTON ST | ||||||||
| Address2: | |||||||||
| City: | FORDYCE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717423055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703525122 | ||||||||
| FaxNumber: | 8703525127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2015 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A1603037 | AR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | P1809130 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.