Provider Demographics
NPI:1659699130
Name:SARABIA, PENNY DAWN (MED)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:DAWN
Last Name:SARABIA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 W BROADWAY ST STE 51A
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2501
Mailing Address - Country:US
Mailing Address - Phone:580-226-9388
Mailing Address - Fax:580-226-9395
Practice Address - Street 1:2015 W BROADWAY ST STE 51A
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2501
Practice Address - Country:US
Practice Address - Phone:580-226-9388
Practice Address - Fax:580-226-9395
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
OK4682101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool