Provider Demographics
NPI:1699247981
Name:PENNINGTON, LUCINDA (MS, MA)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MS, MA
Other - Prefix:
Other - First Name:ELYSABETH
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:941 SELBY CT
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8291
Mailing Address - Country:US
Mailing Address - Phone:816-255-5375
Mailing Address - Fax:
Practice Address - Street 1:17101 E 203RD ST
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078
Practice Address - Country:US
Practice Address - Phone:816-255-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101Y00000X, 103K00000X, 1744R1102X, 225C00000X, 376J00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1744R1102XOther Service ProvidersSpecialistResearch Study
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No376J00000XNursing Service Related ProvidersHomemaker