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General NPI Number Information
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NPI Number | 1629085972
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Entity Type | Individual
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Provider Name | MARK ALLEN DENNEY LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 777 N DETROIT ST
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City | LAGRANGE
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State | IN
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Zip | 46761-1111
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Country | US
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Telephone | 260-463-8394
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Fax | 260-463-3600
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Provider Business Mailing Address
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Address Line | 777 N DETROIT ST
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City | LAGRANGE
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State | IN
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Zip | 46761-1111
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Country | US
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Telephone | 260-463-8394
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Fax | 260-463-3600
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001512A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0500
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License Number State | KY
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