Provider Demographics
NPI:1609232628
Name:PENNIE MARKUS LMHC, INC.
Entity Type:Organization
Organization Name:PENNIE MARKUS LMHC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-843-7101
Mailing Address - Street 1:2640 LAKE SHORE DR
Mailing Address - Street 2:SUITE 609
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-4665
Mailing Address - Country:US
Mailing Address - Phone:561-843-7101
Mailing Address - Fax:561-459-4030
Practice Address - Street 1:2640 LAKE SHORE DR
Practice Address - Street 2:SUITE 609
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4665
Practice Address - Country:US
Practice Address - Phone:561-843-7101
Practice Address - Fax:561-459-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6216101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty