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General NPI Number Information
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NPI Number | 1649660184
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Entity Type | Organization
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Legal Business Name | JODY PENDLETON PSYD, LLC
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 2480 HIGH ST
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City | CANON CITY
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State | CO
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Zip | 81212-8746
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Country | US
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Telephone | 719-251-0773
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Fax |
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Provider Business Mailing Address
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Address Line | 2480 HIGH ST
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City | CANON CITY
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State | CO
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Zip | 81212-8746
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Country | US
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Telephone | 719-251-0773
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | DR. JODY L PENDLETON
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Credential | PSYD, LPC
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Telephone | 719-251-0773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2859
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License Number State | CO
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