Provider Demographics
NPI:1174375380
Name:PENNEY, JENNIFER CLARK (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLARK
Last Name:PENNEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 SANDALWOOD CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63038-1548
Mailing Address - Country:US
Mailing Address - Phone:314-604-4050
Mailing Address - Fax:
Practice Address - Street 1:4121 UNION RD STE 225
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1093
Practice Address - Country:US
Practice Address - Phone:314-730-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health