Provider Demographics
NPI:1831402304
Name:PENNER, ANDREW MICHAEL (PLPC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:PENNER
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E 18TH ST
Mailing Address - Street 2:STE. 104
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1358
Mailing Address - Country:US
Mailing Address - Phone:660-584-5560
Mailing Address - Fax:660-584-5562
Practice Address - Street 1:14 E 18TH ST
Practice Address - Street 2:STE. 104
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1358
Practice Address - Country:US
Practice Address - Phone:660-584-5560
Practice Address - Fax:660-584-5562
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010023789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health