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NPI Code Detail

MEDICARE: CAROL PENDLETON, LLC

MEDICARE: CAROL PENDLETON, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMG60307219WA

General Provider Information

NPI Number : 1093059479
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAROL PENDLETON, LLC
Provider Business Mailing Address
First Line : 11718 ARROW POINT DR NE
Second Line :
City : BAINBRIDGE ISLAND
State : WA
Zip : 98110-1425
Country : US
Telephone Number : 206-355-8532
Fax Number :
Provider Business Practice Location Address
First Line : 11718 ARROW POINT DR NE
Second Line :
City : BAINBRIDGE ISLAND
State : WA
Zip : 98110-1425
Country : US
Telephone Number : 206-355-8532
Fax Number :
Authorized Official
Title or Position : THERAPIST
Name : CAROL PENDLETON
Credential : MA, LMFTA, CMHS,
Telephone Number : 206-355-8532
Provider Enumeration Date : 11/26/2012
Last Update Date : 12/04/2012

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