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General NPI Number Information
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NPI Number | 1992776678
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Entity Type | Individual
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Provider Name | MARK G PENDLETON PHD
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 3015 47TH STREET SUITE E-3
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City | BOULDER
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State | CO
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Zip | 80301-5437
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Country | US
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Telephone | 303-444-6335
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Fax | 303-443-9641
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Provider Business Mailing Address
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Address Line | 3015 47TH STREET SUITE E-3
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City | BOULDER
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State | CO
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Zip | 80301-5437
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Country | US
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Telephone | 303-444-6335
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Fax | 303-443-9641
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 797
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 797
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 797
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 797
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License Number State | CO
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