Provider Demographics
NPI:1114181179
Name:PENEWIT, W H (DMIN)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:H
Last Name:PENEWIT
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE LOOP 820
Mailing Address - Street 2:SUITE 200 B
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 NE LOOP 820
Practice Address - Street 2:SUITE 200 B
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4634
Practice Address - Country:US
Practice Address - Phone:817-898-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47174101YM0800X
FL1251101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health