Provider Demographics
NPI:1366877896
Name:ALGRAVA, PENNY ANN (LPC)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:ANN
Last Name:ALGRAVA
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 1:2205 BECKETT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3701
Mailing Address - Country:US
Mailing Address - Phone:318-675-0224
Mailing Address - Fax:318-675-0226
Practice Address - Street 1:2205 BECKETT ST APT 1
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3701
Practice Address - Country:US
Practice Address - Phone:318-675-0224
Practice Address - Fax:318-675-0226
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3701101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health