| NPI | 1851778252 |
|---|---|
| Former Name | PENNY LYNN WILLOUGHBY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2024-08-21 |