Provider Demographics
NPI:1548762511
Name:SMALL, TONYA S (LMHC)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:S
Last Name:SMALL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:S
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC-A
Mailing Address - Street 1:240 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3988
Mailing Address - Country:US
Mailing Address - Phone:765-288-1928
Mailing Address - Fax:765-741-0335
Practice Address - Street 1:1860 NORTHWOOD PLZ
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1037
Practice Address - Country:US
Practice Address - Phone:317-346-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000535A101YM0800X
IN39003844A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health