Healthcare Provider Details

I. General information

NPI: 1487998217
Provider Name (Legal Business Name): CAROL ANNE PENDLETON LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11718 ARROW POINT DR NE
BAINBRIDGE ISLAND WA
98110-1425
US

IV. Provider business mailing address

11718 ARROW POINT DR NE
BAINBRIDGE ISLAND WA
98110-1425
US

V. Phone/Fax

Practice location:
  • Phone: 206-355-8532
  • Fax:
Mailing address:
  • Phone: 206-355-8532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60307219
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: