Provider Demographics
NPI:1578696555
Name:PENTON, CHERRI E (PHD , MP)
Entity Type:Individual
Prefix:DR
First Name:CHERRI
Middle Name:E
Last Name:PENTON
Suffix:
Gender:F
Credentials:PHD , MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:232 SHADY OAKS CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-5349
Mailing Address - Country:US
Mailing Address - Phone:225-755-6138
Mailing Address - Fax:225-755-2573
Practice Address - Street 1:1805 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-1919
Practice Address - Country:US
Practice Address - Phone:225-923-3420
Practice Address - Fax:225-922-9316
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMP.1026103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1409588Medicaid