Individual
DANIEL RAY PENNYWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1505 DOCTORS DR, BOSSIER CITY, LA 71111-3321
(318) 584-7133
Mailing address
1505 DOCTORS DR, BOSSIER CITY, LA 71111-3321
(318) 584-7133
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CIT-5353
LA
171M00000X
Case Manager/Care Coordinator
CIT-5353
LA
Other
Enumeration date
10/15/2021
Last updated
10/22/2021
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