Provider Demographics
NPI:1508175498
Name:PENTON, BETTY JO (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JO
Last Name:PENTON
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:RR 1 BOX 256
Mailing Address - Street 2:
Mailing Address - City:EQUALITY
Mailing Address - State:AL
Mailing Address - Zip Code:36026-9122
Mailing Address - Country:US
Mailing Address - Phone:334-531-3876
Mailing Address - Fax:
Practice Address - Street 1:103 W TUSKEENA ST
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-2420
Practice Address - Country:US
Practice Address - Phone:334-531-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2329101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral