Healthcare Provider Details

I. General information

NPI: 1134435019
Provider Name (Legal Business Name): PENNY COLLINS LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PENNY DEAKIN LPC, NCC

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 CIRCLE P DR
PRESCOTT AZ
86303-5525
US

IV. Provider business mailing address

332 CIRCLE P DR
PRESCOTT AZ
86303-5525
US

V. Phone/Fax

Practice location:
  • Phone: 715-486-6007
  • Fax:
Mailing address:
  • Phone: 715-486-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-15394
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3452-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number311116
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: