Provider Demographics
NPI:1538319900
Name:PENNINGTON, TERESA L (LPC, MS, BSE)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LPC, MS, BSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 CHEATHAM
Mailing Address - Street 2:
Mailing Address - City:GURDON
Mailing Address - State:AR
Mailing Address - Zip Code:71743
Mailing Address - Country:US
Mailing Address - Phone:870-353-6555
Mailing Address - Fax:
Practice Address - Street 1:829 HALBERT ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-2607
Practice Address - Country:US
Practice Address - Phone:501-332-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1108063101YM0800X
ARA0910115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health