Individual
MICHAEL REYNARD PENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
175 PHILPOTT LN, BEAVER, WV 25813-9501
(304) 254-9262
Mailing address
175 PHILPOTT LN, BEAVER, WV 25813-9501
(304) 254-9262
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/28/2022
Last updated
04/20/2023
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