Provider Demographics
NPI:1427304195
Name:TERRI PENDLETON,INC
Entity type:Organization
Organization Name:TERRI PENDLETON,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-785-7472
Mailing Address - Street 1:2708 ALT 19 STE 507-14
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2665
Mailing Address - Country:US
Mailing Address - Phone:727-785-7472
Mailing Address - Fax:727-785-7429
Practice Address - Street 1:2708 ALT 19 STE 507-14
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2665
Practice Address - Country:US
Practice Address - Phone:727-785-7472
Practice Address - Fax:727-785-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-3827261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health