Pennington, Timothy Paul
Pennington, Timothy Paul is an sole proprietor health care provider with primary practice located at 1500 N Westwood Blvd , Poplar Bluff MO 63901-3318. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Pennington, Timothy Paul can be contacted via phone (573) 686-4151.Contact Information
Primary practice address
1500 N Westwood Blvd
Poplar Bluff MO 63901-3318
Phone: (573) 686-4151
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 2004024505 | Missouri |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 2042-C | Arkansas |
Profile Details
| NPI number | 1245209329 |
|---|---|
| LBN Legal business name | Pennington, Timothy Paul |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 14th, 2006 |
| Last updated | Mar 13th, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245209329 | NPPES |
| Missouri | Other | 11583081 | CAQH PROVIDER ID |
| Missouri | Other | 2042-C | CAQH PROVIDER ID |
| Missouri | Other | 2004024505 | CAQH PROVIDER ID |
| Missouri | MEDICAID | 490048709 | CAQH PROVIDER ID |
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