Provider Demographics
NPI:1073362984
Name:PENNINGTON, GAITHA (LPC)
Entity type:Individual
Prefix:
First Name:GAITHA
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 LAQUINTA DR
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-4107
Mailing Address - Country:US
Mailing Address - Phone:409-338-6363
Mailing Address - Fax:
Practice Address - Street 1:14405 LAQUINTA DR
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-4107
Practice Address - Country:US
Practice Address - Phone:409-338-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019030487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional