Provider Demographics
NPI:1396273975
Name:PENNIE, GERALD WAYNE (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WAYNE
Last Name:PENNIE
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 22ND ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1142
Mailing Address - Country:US
Mailing Address - Phone:713-417-6057
Mailing Address - Fax:
Practice Address - Street 1:3805 22ND ST STE 1C
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1142
Practice Address - Country:US
Practice Address - Phone:713-417-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional