Daniel Ray Pennywell

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CIT-5353 Issued in LA

Practice address

1505 Doctors Dr
Bossier City, LA 71111-3321

Phone

(318) 584-7133

NPI assigned

Oct 15, 2021

Last updated

Oct 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Active Recovery LLC

  • Addiction (Substance Use Disorder) Counselor
  • Shreveport, LA
  • NPI 1285998716
  NPD (past)

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

{
    "created_epoch": "1634256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1376206482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 DOCTORS DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113321",
            "telephone_number": "318-584-7133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 DOCTORS DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113321",
            "telephone_number": "318-584-7133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3821 Southern Ave",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711061033",
            "country_code": "US",
            "telephone_number": "318-946-8157",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENNYWELL",
        "first_name": "DANIEL",
        "middle_name": "RAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-15",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "LA",
            "license": "CIT-5353",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "LA",
            "license": "CIT-5353",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Akers Pearson, PT, DPT
• Ellen Dean Pedeaux, PT, DPT
• Pediatric Dental Partners, LLP
• Mardosha Peek
• Tracie Pendarvis
• Crystal Peoples-Mims
• Leigh Perry Peregoy, LCSW
• Jonette Peretik, LPC
• Matthew Troy Perkins, MD
• Hannah M Perot, MCD/CF-SLP

• Addiction (Substance Use Disorder) Counselor in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Addiction (Substance Use Disorder) Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; 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.