Healthcare Provider Details

I. General information

NPI: 1063997823
Provider Name (Legal Business Name): CINDY PENDREY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 GOLF COURSE RD SE SUITE A
RIO RANCHO NM
87124
US

IV. Provider business mailing address

PO BOX 45681
RIO RANCHO NM
87174-5681
US

V. Phone/Fax

Practice location:
  • Phone: 505-803-4677
  • Fax:
Mailing address:
  • Phone: 505-803-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CINDY PENDREY
Title or Position: LICENSED PRO. CLINICAL COUNSELOR
Credential: LPCC
Phone: 505-803-4677