Provider Demographics
NPI:1457741589
Name:PENDON, JAMIE NOELLE (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NOELLE
Last Name:PENDON
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:NOELLE
Other - Last Name:YOTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:422 W RIVERSIDE AVE STE 518
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0302
Mailing Address - Country:US
Mailing Address - Phone:509-640-6790
Mailing Address - Fax:
Practice Address - Street 1:422 W RIVERSIDE AVE STE 518
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0302
Practice Address - Country:US
Practice Address - Phone:509-640-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60621616101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2056510Medicaid