Provider Demographics
NPI:1386746493
Name:PANNETT, SANDY (LPC,LMFT,LCDC)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:
Last Name:PANNETT
Suffix:
Gender:F
Credentials:LPC,LMFT,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 SILVERWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8612
Mailing Address - Country:US
Mailing Address - Phone:903-504-5501
Mailing Address - Fax:903-504-5551
Practice Address - Street 1:3612 SILVERWOOD DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8612
Practice Address - Country:US
Practice Address - Phone:903-504-5501
Practice Address - Fax:903-504-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9022101YP2500X
TX4457106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist