Healthcare Provider Details

I. General information

NPI: 1821143512
Provider Name (Legal Business Name): RICHARD RAY PENDLETON SR. MS, LIMHP, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E 5TH ST
LEXINGTON NE
68850-2110
US

IV. Provider business mailing address

PO BOX 519
LEXINGTON NE
68850-0519
US

V. Phone/Fax

Practice location:
  • Phone: 308-324-6754
  • Fax:
Mailing address:
  • Phone: 308-324-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1876
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3534
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLIMHP 1050
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: