Provider Demographics
NPI:1609121177
Name:PENTON, MARY ELAINE (CDP, LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:PENTON
Suffix:
Gender:F
Credentials:CDP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2802
Mailing Address - Country:US
Mailing Address - Phone:509-477-1521
Mailing Address - Fax:509-477-1635
Practice Address - Street 1:1224 N ASH ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2802
Practice Address - Country:US
Practice Address - Phone:509-477-1521
Practice Address - Fax:509-477-1635
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 00002890101YA0400X
WALH 60158767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health