Provider Demographics
NPI:1649347063
Name:AYRES, PENNY L (LCPC)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:L
Last Name:AYRES
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:PENNY
Other - Middle Name:L
Other - Last Name:AYRES AMARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2501 STIRLING CIR
Mailing Address - Street 2:UNIT 410
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698
Mailing Address - Country:US
Mailing Address - Phone:630-220-9587
Mailing Address - Fax:
Practice Address - Street 1:2501 STIRLING CIR
Practice Address - Street 2:UNIT 410
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:630-220-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005356101YP2500X
FLMH19201101YP2500X
IL180005356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH19201OtherCOUNSELOR
IL180005356OtherLCPC