Provider Demographics
NPI:1851596910
Name:AUGUSTIN, PENNY (LPC)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:AUGUSTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E WHITEFISH RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1338
Mailing Address - Country:US
Mailing Address - Phone:262-268-0208
Mailing Address - Fax:
Practice Address - Street 1:325 E WHITEFISH RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1338
Practice Address - Country:US
Practice Address - Phone:262-268-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2682-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional