Doctor Name: | DR. PENNIE R. DEXTER |
NPI Number: | 1053418475 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PSY2854 |
Business Practice Address: | 159 W. 2nd St. Nederland, CO - 80466 |
Business Phone Number: | 3036013416 |
Business Fax Number: | 3032589356 |
Mailing Address: | Po Box 1102, Keystone Counseling, Llc NEDERLAND |
State: | CO |
Postal Code: | 804661102 |
Phone Number: | 3036013416 |
Fax Number: | 3032589356 |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY2854 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |