Provider Demographics
NPI:1972067353
Name:PALENCER, TRISHA (LCSW)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:PALENCER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 RONALD REAGAN PKWY STE 383
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6914
Mailing Address - Country:US
Mailing Address - Phone:317-217-2711
Mailing Address - Fax:
Practice Address - Street 1:1115 RONALD REAGAN PKWY STE 383
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6914
Practice Address - Country:US
Practice Address - Phone:317-217-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001597A101YA0400X
IN34007885A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)