Carol A Pendley, LPC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

17613 Issued in TX

Practice address

101 E Gilmer St.
Big Sandy, TX 75755-2101

Phone

(903) 636-4657

Fax

(214) 614-2316

NPI assigned

Feb 14, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476748800000",
    "number": "1609919307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 N PEARL ST",
            "city": "BIG SANDY",
            "state": "TX",
            "postal_code": "757552101",
            "telephone_number": "903-636-4657",
            "fax_number": "214-614-2316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E GILMER ST.",
            "city": "BIG SANDY",
            "state": "TX",
            "postal_code": "757552101",
            "telephone_number": "903-636-4657",
            "fax_number": "214-614-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDLEY",
        "first_name": "CAROL",
        "middle_name": "A",
        "credential": "LPC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-14",
        "last_updated": "2016-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "17613",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "17613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "83358L",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149784401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Big Sandy, TX
• Providers in Big Sandy, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.