Healthcare Provider Details

I. General information

NPI: 1427304195
Provider Name (Legal Business Name): TERRI PENDLETON,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 ALT 19 STE 507-14
PALM HARBOR FL
34683-2665
US

IV. Provider business mailing address

2708 ALT 19 STE 507-14
PALM HARBOR FL
34683-2665
US

V. Phone/Fax

Practice location:
  • Phone: 727-785-7472
  • Fax: 727-785-7429
Mailing address:
  • Phone: 727-785-7472
  • Fax: 727-785-7429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMH-3827
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMH-3827
License Number StateFL

VIII. Authorized Official

Name: TERRI PENDLETON
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 727-785-7472