Healthcare Provider Details

I. General information

NPI: 1255387197
Provider Name (Legal Business Name): JODY L PENDLETON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 HIGH ST
CANON CITY CO
81212-8746
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-2591
  • Fax:
Mailing address:
  • Phone: 970-624-4036
  • Fax: 970-490-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0002859
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: