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NPI Code Detail

MEDICARE: MS. DAWN W PENDLETON LMFT

MEDICARE: MS. DAWN W PENDLETON LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist0524KY

General Provider Information

NPI Number : 1114143039
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DAWN W PENDLETON LMFT
Provider Business Mailing Address
First Line : 117 VERNON AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-2036
Country : US
Telephone Number : 502-895-7668
Fax Number :
Provider Business Practice Location Address
First Line : 4000 KRESGE WAY
Second Line : BAPTIST HOSPITAL EAST - OPT. BEHAVIORAL HEALTH
City : LOUISVILLE
State : KY
Zip : 40207-4605
Country : US
Telephone Number : 502-896-7109
Fax Number : 502-896-7277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 07/08/2007

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