Individual
PENNIE BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC, LMFT
Contact information
Practice address
20655 RUSSELL CORNER RD, GRAVETTE, AR 72736-8955
(479) 366-2279
Mailing address
PO BOX 285, GRAVETTE, AR 72736-0285
(479) 366-2279
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P2305020
AR
106H00000X
Marriage & Family Therapist
M2305003
AR
Other
Enumeration date
03/25/2021
Last updated
06/13/2023
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