Provider Demographics
NPI:1174838148
Name:PENDLETON, MARQUITA HALL
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:HALL
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NW 83RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-3319
Mailing Address - Country:US
Mailing Address - Phone:405-840-2444
Mailing Address - Fax:
Practice Address - Street 1:210 NW 83RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-3319
Practice Address - Country:US
Practice Address - Phone:405-840-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst