Provider Demographics
NPI:1639853641
Name:PENNINGTON, MEGAN OLEVIA (RBT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:OLEVIA
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OVERLOOK WAY APT 3202
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-3309
Mailing Address - Country:US
Mailing Address - Phone:936-933-6722
Mailing Address - Fax:
Practice Address - Street 1:1812 E MURCHISON ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-7836
Practice Address - Country:US
Practice Address - Phone:903-729-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-267763106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician