Individual
FLOYD MARTIN PENNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, CADC III, CSAT
Contact information
Practice address
12414 E BURNSIDE ST, PORTLAND, OR 97233-1044
(503) 997-8664
(503) 254-2196
Mailing address
12414 E BURNSIDE ST, PORTLAND, OR 97233-1044
(503) 997-8664
(503) 254-2196
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
09-12-74
OR
101YP2500X
Professional Counselor
Primary
C2177
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407000383
—
OR
Enumeration date
11/05/2008
Last updated
02/21/2015
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