Provider Demographics
NPI:1568404028
Name:PENTON, ROBERT WAYNE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WAYNE
Last Name:PENTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 S WILLIS ST
Mailing Address - Street 2:STE.213
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4068
Mailing Address - Country:US
Mailing Address - Phone:325-690-1979
Mailing Address - Fax:325-690-1979
Practice Address - Street 1:1290 S WILLIS ST
Practice Address - Street 2:STE.213
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4068
Practice Address - Country:US
Practice Address - Phone:325-690-1979
Practice Address - Fax:325-690-1979
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS61ZOtherBLUE CROSS/BLUE SHIELD
TX00S61ZMedicare ID - Type Unspecified
TXS61ZOtherBLUE CROSS/BLUE SHIELD
TX126601Medicare UPIN