Provider Demographics
NPI:1104308899
Name:NIKKI PENN COUNSELING AND CONSULTING, PLLC
Entity type:Organization
Organization Name:NIKKI PENN COUNSELING AND CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITTERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-793-0071
Mailing Address - Street 1:PO BOX 2523
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-2523
Mailing Address - Country:US
Mailing Address - Phone:870-793-0071
Mailing Address - Fax:888-683-9687
Practice Address - Street 1:1275 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3548
Practice Address - Country:US
Practice Address - Phone:870-793-0071
Practice Address - Fax:888-683-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR092L101YA0400X
ARM0405001106H00000X
ARP0405022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARM0405001OtherLMFT
ARP0405022OtherLPC