Provider Demographics
NPI:1821200288
Name:VAN DER WESTHUIZEN, PENELOPE CHERYL (MED LPC)
Entity Type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:CHERYL
Last Name:VAN DER WESTHUIZEN
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S. CENTRAL EXPRESSWAY
Mailing Address - Street 2:SUITE 435
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6037
Mailing Address - Country:US
Mailing Address - Phone:972-454-0016
Mailing Address - Fax:
Practice Address - Street 1:811 S CENTRAL EXPY # 435
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7415
Practice Address - Country:US
Practice Address - Phone:972-454-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional