Provider Demographics
NPI:1013608157
Name:PENNEY, JOVANNA
Entity Type:Individual
Prefix:MRS
First Name:JOVANNA
Middle Name:
Last Name:PENNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 S PONDEROSA PKWY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-8243
Mailing Address - Country:US
Mailing Address - Phone:619-672-9714
Mailing Address - Fax:
Practice Address - Street 1:510 E MOELLER ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2612
Practice Address - Country:US
Practice Address - Phone:928-420-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist