Provider Demographics
NPI:1275319238
Name:ANDREW R PENN, LMHC, LLC
Entity Type:Organization
Organization Name:ANDREW R PENN, LMHC, LLC
Other - Org Name:ANDREW R PENN, LMHC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-405-2450
Mailing Address - Street 1:PO BOX 48844
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-8844
Mailing Address - Country:US
Mailing Address - Phone:727-405-4250
Mailing Address - Fax:813-291-7788
Practice Address - Street 1:7402 N 56TH ST STE 355
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-7700
Practice Address - Country:US
Practice Address - Phone:727-405-2450
Practice Address - Fax:813-291-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty