FLOYD MARTIN PENNA LPC CADC III CSAT NPI 1407000383

NPI Information

NPI: 1407000383
Provider Name: FLOYD MARTIN PENNA, LPC, CADC III, CSAT
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

Address:
12414 E BURNSIDE ST
PORTLAND, OR
ZIP 97233
Phone: (503) 997-8664
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Floyd Martin Penna, LPC, CADC III, CSAT is a professional counselor in Portland, OR. Floyd Martin Penna, LPC, CADC III, CSAT NPI is 1407000383. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

12414 E BURNSIDE ST
PORTLAND, OR
ZIP 97233-044
Phone: (503) 997-8664
Fax: (503) 254-2196

The enumeration date for this NPI number is 11/5/2008 and was last updated on 2/21/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	09-12-74	OREGON	No
2	101YP2500X	Counselor	Professional	C2177	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1407000383	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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