Provider Demographics
NPI:1043946015
Name:PINE DOVE, PENNY ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:ELIZABETH
Last Name:PINE DOVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 R O DR
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6883
Mailing Address - Country:US
Mailing Address - Phone:512-632-5385
Mailing Address - Fax:
Practice Address - Street 1:4005 SPICEWOOD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8666
Practice Address - Country:US
Practice Address - Phone:512-632-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX401771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical