Provider Demographics
NPI:1467808980
Name:PENDLETON, LOTHAIR WILLIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:LOTHAIR
Middle Name:WILLIAM
Last Name:PENDLETON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 E 13800 S
Mailing Address - Street 2:SUITE #4
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5010
Mailing Address - Country:US
Mailing Address - Phone:801-816-1801
Mailing Address - Fax:801-501-0249
Practice Address - Street 1:14241 S REDWOOD RD
Practice Address - Street 2:SUITE # 100
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-5211
Practice Address - Country:US
Practice Address - Phone:801-816-1801
Practice Address - Fax:801-501-0249
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT135945-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical