Provider Demographics
NPI:1649619883
Name:PENDLETON, TIFFANY JOYCE (LMSW)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:JOYCE
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 CHURCHILL CIR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-7345
Mailing Address - Country:US
Mailing Address - Phone:662-617-5404
Mailing Address - Fax:
Practice Address - Street 1:354 CHURCHILL CIR
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-7345
Practice Address - Country:US
Practice Address - Phone:662-617-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM7295104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker