MEDICARE: MS. MARCIETTA GAYLE PENDLETON LMFT

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
1	106H00000X	Marriage & Family Therapist	5005	TX

General Provider Information

NPI Number	:	1356321814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIETTA GAYLE PENDLETON LMFT

Provider Business Mailing Address
First Line	:	14511 MEYERSVILLE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-4323
Country	:	US
Telephone Number	:	281-458-5905
Fax Number	:	281-458-5905

Provider Business Practice Location Address
First Line	:	14511 MEYERSVILLE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-4323
Country	:	US
Telephone Number	:	281-458-5905
Fax Number	:	281-458-5905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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