Provider Demographics
NPI:1649205402
Name:PENNINGTON, JONDRA ANN (MS, MFT)
Entity Type:Individual
Prefix:
First Name:JONDRA
Middle Name:ANN
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66419 SAN JUAN RD
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-2411
Mailing Address - Country:US
Mailing Address - Phone:760-251-8822
Mailing Address - Fax:760-251-8821
Practice Address - Street 1:78150 CALLE TAMPICO
Practice Address - Street 2:SUITE 207C
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253
Practice Address - Country:US
Practice Address - Phone:769-777-9939
Practice Address - Fax:760-251-8821
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist