Basic Information
| Provider Information | |||||||||
| NPI: | 1912143470 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PENNOCK CENTER FOR COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 S 21ST AVE | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806012581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036559065 | ||||||||
| FaxNumber: | 3036550336 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 S 21ST AVE | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806012581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036559065 | ||||||||
| FaxNumber: | 3036550336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2009 | ||||||||
| LastUpdateDate: | 01/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | PIERCE | ||||||||
| AuthorizedOfficialFirstName: | JODY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3036559065 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | CO | Y | Agencies | Voluntary or Charitable |
No ID Information.