Doctor Name: | HAL I PENDERGRASS |
NPI Number: | 1073677738 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | 01632 |
Business Practice Address: | 12131 Dorsett Rd Suite 220 Maryland Heights, MO - 630432418 |
Business Phone Number: | 3142980900 |
Business Fax Number: | 3142989274 |
Mailing Address: | 12131 Dorsett Rd, Suite 220 MARYLAND HEIGHTS |
State: | MO |
Postal Code: | 630432418 |
Phone Number: | 3142980900 |
Fax Number: | 3142989274 |
NPI Enumeration Date: | 12/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 01632 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |