Floyd Martin Penna, LPC, CADC III, CSAT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C2177 Issued in OR

Practice address

12414 E Burnside St
Portland, OR 97233-1044

Phone

(503) 997-8664

Fax

(503) 254-2196

NPI assigned

Nov 5, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424476800000",
    "number": "1407000383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12414 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331044",
            "telephone_number": "503-997-8664",
            "fax_number": "503-254-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12414 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331044",
            "telephone_number": "503-997-8664",
            "fax_number": "503-254-2196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNA",
        "first_name": "FLOYD",
        "middle_name": "MARTIN",
        "credential": "LPC, CADC III, CSAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-05",
        "last_updated": "2015-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "09-12-74",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C2177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407000383",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara N. Penn, M.A., QMHP
• Melissa Renee Penn, C.D.A. - E.F.D.A.
• Morgan Penn, PT
• Regan Ann Penn
• Tristan Penn
• Jason Pennell, PHARMD
• Olivia L Pennelle, MSW, CWSA
• Ashley Penner, AU.D.
• Aubra Danielle Penner
• Sara Penner, LCSW

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2015; 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.