Jacob Penvose, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC012394 Issued in PA

Practice address

3 S Brady St Ste 205
Du Bois, PA 15801-2159

Phone

(814) 371-1088

NPI assigned

May 18, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brookville Behavioral Health Inc.

  • Community/Behavioral Health Agency
  • Du Bois, PA
  • NPI 1326117359
  NPD

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

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1306469937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 S BRADY ST STE 205",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158012159",
            "telephone_number": "814-591-6841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 S BRADY ST STE 205",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158012159",
            "telephone_number": "814-371-1088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENVOSE",
        "first_name": "JACOB",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-18",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC012394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Penn Highlands Healthcare
• Penn Highlands Home Medical Equipment LLC
• Penn Highlands Life'S Journey
• Penn Highlands Radiology Inc
• Penn Traffic Co
• Peritech Home Health Associates LLC
• Peritech Home Health Associates, LLC
• Amber Nicole Perry, DO
• Ross William Perry, LCSW
• Personal Habilitation Services LLC

• Professional Counselor in Du Bois, PA
• Providers in Du Bois, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; 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.