Active NPI
Gerald Wayne Pennie, PHD, LPC, NCC
- Professional Counselor
- Lubbock, TX
National Provider Identifier
1396273975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 72286
- Practice address
- 3805 22ND St Ste 1C
Lubbock, TX 79410-1142 - Phone
- (713) 417-6057
- NPI assigned
- May 26, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 72286 | TX | Primary |
Addresses
Primary practice location
3805 22ND St Ste 1C
Lubbock, TX 79410-1142
Mailing address
3805 22ND St Ste 1C
Lubbock, TX 79410-1142
Phone (713) 417-6057
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72286 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1396273975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3805 22ND ST STE 1C",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794101142",
"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"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNIE",
"first_name": "GERALD",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "PHD, LPC, NCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-26",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "72286",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.