Provider Demographics
NPI:1073264172
Name:PENNICK, SHELBY REED (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:REED
Last Name:PENNICK
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 WELLINGTON WAY STE 160
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-2002
Mailing Address - Country:US
Mailing Address - Phone:859-800-6319
Mailing Address - Fax:859-207-5481
Practice Address - Street 1:1056 WELLINGTON WAY STE 160
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-2002
Practice Address - Country:US
Practice Address - Phone:859-800-6319
Practice Address - Fax:859-207-5481
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY278242101YP2500X
KY260470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health