Provider Demographics
NPI:1609468941
Name:PENNINGTON, KRYSTAL (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 9800 BOX 537
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AP
Mailing Address - Zip Code:96303-0537
Mailing Address - Country:US
Mailing Address - Phone:214-577-4929
Mailing Address - Fax:
Practice Address - Street 1:9125 TATE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-7691
Practice Address - Country:US
Practice Address - Phone:214-577-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health