Provider Demographics
NPI:1750626123
Name:PENDLEY AND ASSOCIATES, INC
Entity type:Organization
Organization Name:PENDLEY AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:PENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:307-742-6898
Mailing Address - Street 1:PO BOX 1304
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073-1304
Mailing Address - Country:US
Mailing Address - Phone:307-742-6898
Mailing Address - Fax:307-742-6414
Practice Address - Street 1:1277 N 15TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2343
Practice Address - Country:US
Practice Address - Phone:307-742-6222
Practice Address - Fax:307-742-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty