Provider Demographics
NPI:1083891691
Name:PENIGAR, LEWIS HERMAN (LPC)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:HERMAN
Last Name:PENIGAR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 LINDSEY ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-2730
Mailing Address - Country:US
Mailing Address - Phone:817-535-7992
Mailing Address - Fax:
Practice Address - Street 1:1609 LINDSEY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-2730
Practice Address - Country:US
Practice Address - Phone:817-535-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional