Provider Demographics
NPI:1538557772
Name:PENDLEY, MEGAN (PLMHP, PCMSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PENDLEY
Suffix:
Gender:F
Credentials:PLMHP, PCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 NORTH 75TH STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134
Mailing Address - Country:US
Mailing Address - Phone:402-932-2248
Mailing Address - Fax:402-932-3557
Practice Address - Street 1:2808 NORTH 75TH STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134
Practice Address - Country:US
Practice Address - Phone:402-932-2248
Practice Address - Fax:402-932-3557
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10108101YM0800X
NE6895324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health