Provider Demographics
NPI:1063569440
Name:VAIL, PENNIE M (LPC)
Entity type:Individual
Prefix:MRS
First Name:PENNIE
Middle Name:M
Last Name:VAIL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2591 DALLAS PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8542
Mailing Address - Country:US
Mailing Address - Phone:214-924-8195
Mailing Address - Fax:972-292-3819
Practice Address - Street 1:2591 DALLAS PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8542
Practice Address - Country:US
Practice Address - Phone:214-924-8195
Practice Address - Fax:972-292-3819
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX55-0882189OtherTAX ID NUMBER