Provider Demographics
NPI:1639329634
Name:CAREY-STRATTON, PENNY LYNNE (LPC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:LYNNE
Last Name:CAREY-STRATTON
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16028 STARLING CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3971
Mailing Address - Country:US
Mailing Address - Phone:719-460-6297
Mailing Address - Fax:
Practice Address - Street 1:3020 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4053
Practice Address - Country:US
Practice Address - Phone:813-530-6932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4921101YP2500X
FL16449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101455900Medicaid