Provider Demographics
NPI:1508140971
Name:ENGEDI LIFE CARE, PLLC
Entity type:Organization
Organization Name:ENGEDI LIFE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST & SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERMENDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:512-201-0741
Mailing Address - Street 1:3550 N LAKELINE BLVD STE 170-1515
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3504
Mailing Address - Country:US
Mailing Address - Phone:512-201-0741
Mailing Address - Fax:
Practice Address - Street 1:201 S LAKELINE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2719
Practice Address - Country:US
Practice Address - Phone:512-528-5356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201504251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201504OtherMFT LICENSE