Provider Demographics
NPI:1710126644
Name:PENDLETON, KATHERINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SHANAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:12916 SCHLEICHER TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2286
Mailing Address - Country:US
Mailing Address - Phone:512-517-7975
Mailing Address - Fax:512-323-9490
Practice Address - Street 1:12916 SCHLEICHER TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2286
Practice Address - Country:US
Practice Address - Phone:512-517-7975
Practice Address - Fax:512-323-9490
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX410451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220205302Medicaid