Provider Demographics
NPI:1649844275
Name:CHIMENE, PENNY LEA (LCDC)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:LEA
Last Name:CHIMENE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13838 OLD TEXACO RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302
Mailing Address - Country:US
Mailing Address - Phone:936-202-0232
Mailing Address - Fax:
Practice Address - Street 1:13838 OLD TEXACO RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77302
Practice Address - Country:US
Practice Address - Phone:936-202-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13527101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)