Healthcare Provider Details

I. General information

NPI: 1457449209
Provider Name (Legal Business Name): SARA PENDLETON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/21/2022
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E MARKET ST
JEFFERSONVILLE IN
47130-3309
US

IV. Provider business mailing address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 812-280-0028
  • Fax:
Mailing address:
  • Phone: 812-339-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001473A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: