Individual
LEE THOMAS PENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2100 N MAIN ST STE 304, CROWN POINT, IN 46307-1877
(888) 837-5440
(574) 546-1999
Mailing address
PO BOX 10299, FORT WAYNE, IN 46851-0299
(574) 546-1900
(574) 546-1999
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20043365A
IN
103TC0700X
Clinical Psychologist
263320
KY
103TC1900X
Counseling Psychologist
20043365A
IN
Other
Enumeration date
09/01/2020
Last updated
09/18/2020
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