Provider Demographics
NPI:1114209129
Name:PENDLEY, SKYLA DANELLE (BHRS)
Entity Type:Individual
Prefix:
First Name:SKYLA
Middle Name:DANELLE
Last Name:PENDLEY
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34396 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:OK
Mailing Address - Zip Code:74577-1019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:908 DALLAS ST
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571
Practice Address - Country:US
Practice Address - Phone:405-573-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health