Provider Demographics
NPI:1528632734
Name:PENN, ROMEO AARON (LICENSED PASTORAL CO)
Entity type:Individual
Prefix:
First Name:ROMEO
Middle Name:AARON
Last Name:PENN
Suffix:
Gender:M
Credentials:LICENSED PASTORAL CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 BLUE LAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2372
Mailing Address - Country:US
Mailing Address - Phone:205-977-3003
Mailing Address - Fax:205-977-3939
Practice Address - Street 1:3104 BLUE LAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2372
Practice Address - Country:US
Practice Address - Phone:205-977-3003
Practice Address - Fax:205-977-3939
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20838101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20838OtherPASTORAL COUNSELOR