Provider Demographics
NPI:1366911695
Name:PENDERGRASS, RHONDA LEE
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:LEE
Last Name:PENDERGRASS
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 1:805 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4968
Mailing Address - Country:US
Mailing Address - Phone:615-667-8416
Mailing Address - Fax:615-809-2090
Practice Address - Street 1:805 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4968
Practice Address - Country:US
Practice Address - Phone:615-417-9009
Practice Address - Fax:615-809-2090
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health