Individual
MRS. NICOLA MARIE PENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LMFT
Contact information
Practice address
548 N CENTRAL AVE, BATESVILLE, AR 72501-5405
(870) 793-7162
(870) 612-5173
Mailing address
PO BOX 2112, BATESVILLE, AR 72503-2112
(870) 793-7162
(870) 612-5173
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P0405022
AR
106H00000X
Marriage & Family Therapist
M0405001
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5X867
AR BLUE CROSS BLUE SHIEL
AR
Enumeration date
11/13/2006
Last updated
08/22/2011
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