Healthcare Provider Details

I. General information

NPI: 1689441750
Provider Name (Legal Business Name): STEPHANIE LYN TRENT PHD LMHC LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 W DAFFODIL CT
BLOOMINGTON IN
47403-8201
US

IV. Provider business mailing address

5770 W DAFFODIL CT
BLOOMINGTON IN
47403-8201
US

V. Phone/Fax

Practice location:
  • Phone: 765-586-3168
  • Fax:
Mailing address:
  • Phone: 765-586-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001740A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE2404780
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004456A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: