Provider Demographics
NPI:1972511301
Name:PENNINGTON, LAURA JOY (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JOY
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JOY
Other - Last Name:NAPIERALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2512 SPRINGER ROAD
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-4931
Mailing Address - Country:US
Mailing Address - Phone:479-206-3790
Mailing Address - Fax:479-452-5847
Practice Address - Street 1:127 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-3734
Practice Address - Country:US
Practice Address - Phone:855-675-3339
Practice Address - Fax:883-922-1073
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0805037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR314231719Medicaid