Provider Demographics
NPI:1356930036
Name:PENNINGTON, REBEKKAH (MA, LPC, LCDC)
Entity type:Individual
Prefix:
First Name:REBEKKAH
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MA, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 COLGATE LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5903
Mailing Address - Country:US
Mailing Address - Phone:214-893-9872
Mailing Address - Fax:
Practice Address - Street 1:4205 COLGATE LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5903
Practice Address - Country:US
Practice Address - Phone:214-893-9872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional