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General NPI Number Information
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NPI Number | 1265437495
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Entity Type | Individual
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Provider Name | EDWARD HAROLD PENDLETON MA, LPC, LCDC
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 2004 U S HIGHWAY 190 W
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City | LIVINGSTON
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State | TX
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Zip | 77351-9601
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Country | US
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Telephone | 936-328-5880
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Fax | 936-328-5883
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Provider Business Mailing Address
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Address Line | PO BOX 1047
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City | LIVINGSTON
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State | TX
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Zip | 77351-0018
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Country | US
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Telephone | 936-328-5880
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Fax | 936-328-5883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 17475
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License Number State | TX
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