Provider Demographics
NPI:1689879173
Name:SCHIMMEL PENNINCK, MARIE DANIELLE (MED LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:DANIELLE
Last Name:SCHIMMEL PENNINCK
Suffix:
Gender:F
Credentials:MED LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2587 N WALNUT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7147
Mailing Address - Country:US
Mailing Address - Phone:928-380-6460
Mailing Address - Fax:
Practice Address - Street 1:222 N VERDE ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4636
Practice Address - Country:US
Practice Address - Phone:928-380-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT0326106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist