Pennington, Tina Bates

Pennington, Tina Bates is an sole proprietor health care provider with primary practice located at 308 N Laurel Ln , Nixa MO 65714-8582. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Counselor is her primary health care specialty. Pennington, Tina Bates can be contacted via phone (417) 848-7356.

Contact Information

Primary practice address
308 N Laurel Ln Nixa MO 65714-8582
Phone: (417) 848-7356
Fax: (417) 725-7701
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 2000153606 Missouri
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 2000153606 Missouri
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 2000153606 Missouri

Profile Details

NPI number 1760547723
LBN Legal business name Pennington, Tina Bates
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 27th, 2006
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760547723 NPPES
Missouri Other 11564203 CACQ PROVIDER ID
Missouri Other 2000153606 CACQ PROVIDER ID
Missouri MEDICAID 494644305 CACQ PROVIDER ID

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