Provider Demographics
NPI:1609919307
Name:PENDLEY, CAROL A (LPC-S)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:PENDLEY
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:TX
Mailing Address - Zip Code:75755-2101
Mailing Address - Country:US
Mailing Address - Phone:903-636-4657
Mailing Address - Fax:214-614-2316
Practice Address - Street 1:101 E GILMER ST.
Practice Address - Street 2:
Practice Address - City:BIG SANDY
Practice Address - State:TX
Practice Address - Zip Code:75755-2101
Practice Address - Country:US
Practice Address - Phone:903-636-4657
Practice Address - Fax:214-614-2316
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17613101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83358LOtherBLUE CROSS BLUE SHIELD
TX149784401Medicaid