Provider Demographics
NPI:1821441247
Name:SOUTHERN CHARM THERAPEUTICS, PLLC
Entity Type:Organization
Organization Name:SOUTHERN CHARM THERAPEUTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:PENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:940-577-4551
Mailing Address - Street 1:605 GRAND OAKS CT
Mailing Address - Street 2:
Mailing Address - City:ALVORD
Mailing Address - State:TX
Mailing Address - Zip Code:76225-6020
Mailing Address - Country:US
Mailing Address - Phone:940-577-4551
Mailing Address - Fax:
Practice Address - Street 1:605 GRAND OAKS CT
Practice Address - Street 2:
Practice Address - City:ALVORD
Practice Address - State:TX
Practice Address - Zip Code:76225-6020
Practice Address - Country:US
Practice Address - Phone:940-577-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111652235Z00000X
TX111782235Z00000X
TX111699235Z00000X
TX107282235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty