Active NPI
Edward Harold Pendleton, MA, LPC, LCDC
- Counselor
- Livingston, TX
National Provider Identifier
1265437495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 17475
- Practice address
- 2004 U S Highway 190 W
Livingston, TX 77351-9601 - Phone
- (936) 328-5880
- Fax
- (936) 328-5883
- NPI assigned
- Jun 15, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 17475 | TX | Primary |
Addresses
Primary practice location
2004 U S Highway 190 W
Livingston, TX 77351-9601
Mailing address
PO Box 1047
Livingston, TX 77351-0018
Phone (936) 328-5880
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508236-01 | Medicaid | TX | |
| 2119098 | Other | TX | CIGNA BEHAVIORAL HEALTH |
| 7605707 | Other | TX | AETNA |
| PENDL-0002 | Other | TX | COMPCARE PROVIDER ID |
| 11451816 | Other | TX | CAQH PROVIDER ID |
| 551895 | Other | TX | VALUE OPTIONS |
| 719494000 | Other | TX | MAGELLAN |
| 6088LC | Other | TX | BLUECROSS/BLUESHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17475 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328140800000",
"number": "1265437495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1047",
"city": "LIVINGSTON",
"state": "TX",
"postal_code": "773510018",
"telephone_number": "936-328-5880",
"fax_number": "936-328-5883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2004 U S HIGHWAY 190 W",
"city": "LIVINGSTON",
"state": "TX",
"postal_code": "773519601",
"telephone_number": "936-328-5880",
"fax_number": "936-328-5883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDLETON",
"first_name": "EDWARD",
"middle_name": "HAROLD",
"name_prefix": "Mr.",
"credential": "MA, LPC, LCDC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-15",
"last_updated": "2012-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "17475",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1508236-01",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA BEHAVIORAL HEALTH",
"identifier": "2119098",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7605707",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMPCARE PROVIDER ID",
"identifier": "PENDL-0002",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH PROVIDER ID",
"identifier": "11451816",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "551895",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "719494000",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS/BLUESHIELD",
"identifier": "6088LC",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Livingston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.