| Doctor Name: | MR. ANDREW MICHAEL PENNER |
| NPI Number: | 1831402304 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PLPC |
| License Number: | 2010023789 |
| Business Practice Address: | 14 E 18th St Ste. 104 Higginsville, MO - 640371358 |
| Business Phone Number: | 6605845560 |
| Business Fax Number: | 6605845562 |
| Mailing Address: | 14 E 18th St, Ste. 104 HIGGINSVILLE |
| State: | MO |
| Postal Code: | 640371358 |
| Phone Number: | 6605845560 |
| Fax Number: | 6605845562 |
| NPI Enumeration Date: | 07/26/2010 |
| NPI Last Update Date: | 07/26/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 2010023789 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |