Dr Gerald W Pennie

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

72286 Issued in TX

Legal business name

DR GERALD W PENNIE

Practice address

3805 22ND St Ste 1C
Lubbock, TX 79410-1142

Phone

(713) 417-6057

Fax

(713) 417-6057

NPI assigned

May 31, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gerald Wayne Pennie, PHD, LPC, NCC

Title

Lead Counselor

Phone

(713) 417-6057

Specialties & licenses 3

Addresses

Other names 1

• Gerald Pennie Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502064000000",
    "number": "1235667601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2735 GENOA AVE APT 2B",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794077848",
            "telephone_number": "713-417-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 22ND ST STE 1C",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101142",
            "telephone_number": "713-417-6057",
            "fax_number": "713-417-6057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR GERALD W PENNIE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-31",
        "last_updated": "2017-08-07",
        "status": "A",
        "authorized_official_last_name": "PENNIE",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "LEAD COUNSELOR",
        "authorized_official_telephone_number": "713-417-6057",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LPC, NCC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "TX",
            "license": "72286",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "TX",
            "license": "72286",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "TX",
            "license": "72286",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gerald Pennie",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gerald Pennie",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.