Provider Demographics
NPI:1851315477
Name:DOLLENS-SMITH, PENNY LYNNE (MA, LMFT, LMHC, LSW)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:LYNNE
Last Name:DOLLENS-SMITH
Suffix:
Gender:F
Credentials:MA, LMFT, LMHC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13295 ILLINOIS ST
Mailing Address - Street 2:SUITE 324
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3019
Mailing Address - Country:US
Mailing Address - Phone:317-663-0654
Mailing Address - Fax:866-481-0076
Practice Address - Street 1:13295 ILLINOIS ST
Practice Address - Street 2:SUITE 324
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3019
Practice Address - Country:US
Practice Address - Phone:317-663-0654
Practice Address - Fax:866-481-0076
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001121A101YM0800X
IN35000789A106H00000X
IN33001683A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker