Healthcare Provider Details

I. General information

NPI: 1306273388
Provider Name (Legal Business Name): TIKEISHA DANIELLE PENDLETON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 W SILVERLAKE RD
TUCSON AZ
85713-2728
US

IV. Provider business mailing address

1283 MURFREESBORO PIKE STE 500
NASHVILLE TN
37217-2421
US

V. Phone/Fax

Practice location:
  • Phone: 520-351-8104
  • Fax:
Mailing address:
  • Phone: 800-592-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-13818
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: