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Individual
TIMOTHY PAUL PENNINGTON
Active
Individual
TIMOTHY PAUL PENNINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2004024505
MO
1041C0700X
Clinical Social Worker
2042-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11583081
CAQH PROVIDER ID
MO
01
—
2004024505
CLINICAL SOCIAL WORKER
MO
01
—
2042-C
LCSW
AR
05
—
490048709
—
MO
Enumeration date
03/14/2006
Last updated
03/13/2015
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