Provider Demographics
NPI:1447440755
Name:DS PENROD & ASSOC
Entity type:Organization
Organization Name:DS PENROD & ASSOC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:PENROD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LMHC MAC CADACI
Authorized Official - Phone:317-272-5247
Mailing Address - Street 1:192 N STATE ROAD 267
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123
Mailing Address - Country:US
Mailing Address - Phone:317-272-5247
Mailing Address - Fax:317-272-1340
Practice Address - Street 1:192 N STATE ROAD 267
Practice Address - Street 2:300
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9513
Practice Address - Country:US
Practice Address - Phone:317-272-5247
Practice Address - Fax:317-272-1340
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DS PENROD AND ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000853A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty