Provider Demographics
NPI:1811104359
Name:PENDLETON, PORSHEA (MA, LMFT, CADC I)
Entity type:Individual
Prefix:MS
First Name:PORSHEA
Middle Name:
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:MA, LMFT, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 WILLAMETTE ST
Mailing Address - Street 2:306
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2952
Mailing Address - Country:US
Mailing Address - Phone:541-485-1167
Mailing Address - Fax:
Practice Address - Street 1:767 WILLAMETTE ST
Practice Address - Street 2:306
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2952
Practice Address - Country:US
Practice Address - Phone:541-485-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0709106H00000X
OR07-12-38101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)