Individual
JACOB PENVOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3 S BRADY ST STE 205, DU BOIS, PA 15801-2159
(814) 371-1088
Mailing address
3 S BRADY ST STE 205, DU BOIS, PA 15801-2159
(814) 591-6841
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC012394
PA
Other
Enumeration date
05/18/2020
Last updated
05/18/2020
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