Individual
TINA BATES PENNINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
308 N LAUREL LN, NIXA, MO 65714-8582
(417) 848-7356
(417) 725-7701
Mailing address
PO BOX 2356, NIXA, MO 65714-2356
(417) 848-7356
(417) 725-7701
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2000153606
MO
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2000153606
MO
101YM0800X
Mental Health Counselor
2000153606
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11564203
CACQ PROVIDER ID
MO
01
—
2000153606
L.P.C. LICENSE NUMBER
MO
05
—
494644305
—
MO
Enumeration date
12/27/2006
Last updated
09/11/2025
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