1386746493 NPI number — MRS. SANDY PANNETT LPC,LMFT,LCDC

Table of content: MRS. SANDY PANNETT LPC,LMFT,LCDC (NPI 1386746493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386746493 NPI number — MRS. SANDY PANNETT LPC,LMFT,LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANNETT
Provider First Name:
SANDY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC,LMFT,LCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386746493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3612 SILVERWOOD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75701-8612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-504-5501
Provider Business Mailing Address Fax Number:
903-504-5551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3612 SILVERWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75701-8612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-504-5501
Provider Business Practice Location Address Fax Number:
903-504-5551
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  9022 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 4457 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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