Provider Demographics
NPI:1922403476
Name:PENNER COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PENNER COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSCSW, LCAC
Authorized Official - Phone:620-200-4800
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67504-0772
Mailing Address - Country:US
Mailing Address - Phone:620-200-4800
Mailing Address - Fax:620-662-5621
Practice Address - Street 1:101 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-7147
Practice Address - Country:US
Practice Address - Phone:620-200-4800
Practice Address - Fax:620-662-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS42271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty