Healthcare Provider Details

I. General information

NPI: 1497455562
Provider Name (Legal Business Name): TIANA KORIN PENDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W BULLARD AVE
CLOVIS CA
93612-0900
US

IV. Provider business mailing address

1707 N FANCHER AVE
FRESNO CA
93737-9739
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-3775
  • Fax:
Mailing address:
  • Phone: 559-691-2714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT147583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: