Individual
MR. EDWARD HAROLD PENDLETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC, LCDC
Contact information
Practice address
2004 U S HIGHWAY 190 W, LIVINGSTON, TX 77351-9601
(936) 328-5880
(936) 328-5883
Mailing address
PO BOX 1047, LIVINGSTON, TX 77351-0018
(936) 328-5880
(936) 328-5883
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
17475
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11451816
CAQH PROVIDER ID
TX
05
—
1508236-01
—
TX
01
—
2119098
CIGNA BEHAVIORAL HEALTH
TX
01
—
551895
VALUE OPTIONS
TX
01
—
6088LC
BLUECROSS/BLUESHIELD
TX
01
—
719494000
MAGELLAN
TX
01
—
7605707
AETNA
TX
01
—
PENDL-0002
COMPCARE PROVIDER ID
TX
Enumeration date
06/15/2005
Last updated
02/02/2012
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