Provider Demographics
NPI:1235296302
Name:NORD, PENNY (LCPC)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:NORD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:ARLEE
Mailing Address - State:MT
Mailing Address - Zip Code:59821-0222
Mailing Address - Country:US
Mailing Address - Phone:406-543-2220
Mailing Address - Fax:
Practice Address - Street 1:126 E BROADWAY ST
Practice Address - Street 2:SUITE 18
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4511
Practice Address - Country:US
Practice Address - Phone:406-543-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT251141Medicaid