Individual
MR. KYLE JAMISON PENNIMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LISAC, CADAC
Contact information
Practice address
4020 N 20TH ST STE 302, PHOENIX, AZ 85016-6032
(602) 535-6468
Mailing address
4020 N 20TH ST STE 302, PHOENIX, AZ 85016-6032
(602) 535-6468
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/04/2008
Last updated
07/27/2012
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