Provider Demographics
NPI:1750947594
Name:PENDLETON-HARRIS, LASHAUN NICOLE
Entity type:Individual
Prefix:
First Name:LASHAUN
Middle Name:NICOLE
Last Name:PENDLETON-HARRIS
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 1:1721 REDBAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-0167
Mailing Address - Country:US
Mailing Address - Phone:317-800-0041
Mailing Address - Fax:
Practice Address - Street 1:1721 REDBAY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-0167
Practice Address - Country:US
Practice Address - Phone:317-800-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health