Provider Demographics
NPI:1730232406
Name:PENDER, KATHY (LPCC CCDC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:PENDER
Suffix:
Gender:F
Credentials:LPCC CCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 ORANGE PL STE 410
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4465
Mailing Address - Country:US
Mailing Address - Phone:216-464-3666
Mailing Address - Fax:
Practice Address - Street 1:3690 ORANGE PL STE 410
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4465
Practice Address - Country:US
Practice Address - Phone:216-464-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0000976101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor