Healthcare Provider Details

I. General information

NPI: 1972067353
Provider Name (Legal Business Name): TRISHA PALENCER LCSW, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISHA WILCOX

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 RONALD REAGAN PKWY STE 383
AVON IN
46123-6914
US

IV. Provider business mailing address

1115 RONALD REAGAN PKWY STE 383
AVON IN
46123-6914
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-2711
  • Fax:
Mailing address:
  • Phone: 317-217-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007885A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001597A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: