1043423031 NPI number — PENNY HOUGLAND L.I.C.S.W.

Table of content: PENNY HOUGLAND L.I.C.S.W. (NPI 1043423031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043423031 NPI number — PENNY HOUGLAND L.I.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUGLAND
Provider First Name:
PENNY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.I.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043423031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 HARRIS AVE
Provider Second Line Business Mailing Address:
STE 201H
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-7080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-758-4234
Provider Business Mailing Address Fax Number:
360-758-4234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 HARRIS AVE
Provider Second Line Business Practice Location Address:
STE 201H
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-7080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-758-4234
Provider Business Practice Location Address Fax Number:
360-758-4234
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  885011106 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001718108 . This is a "MOUNTAIN STATE BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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