Provider Demographics
NPI:1629085972
Name:DENNEY, MARK ALLEN (LMFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:DENNEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-1111
Mailing Address - Country:US
Mailing Address - Phone:260-463-8394
Mailing Address - Fax:260-463-3600
Practice Address - Street 1:777 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-1111
Practice Address - Country:US
Practice Address - Phone:260-463-8394
Practice Address - Fax:260-463-3600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001512A106H00000X
KY0500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist