Provider Demographics
NPI:1114563913
Name:PENNINGTON, SHAYE (MMFT)
Entity Type:Individual
Prefix:
First Name:SHAYE
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 8TH AVE S APT 308
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2470
Mailing Address - Country:US
Mailing Address - Phone:517-401-0056
Mailing Address - Fax:
Practice Address - Street 1:210 25TH AVE N STE 1220
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1640
Practice Address - Country:US
Practice Address - Phone:517-401-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1572OtherTN LICENSE