Provider Demographics
NPI:1033602644
Name:PEARSON, WILLIAM O IV (LAMFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:O
Last Name:PEARSON
Suffix:IV
Gender:M
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 UNIVERSITY DR N APT 316
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1844
Mailing Address - Country:US
Mailing Address - Phone:415-342-5367
Mailing Address - Fax:
Practice Address - Street 1:ANNE CARLSEN CENTER
Practice Address - Street 2:3030 24TH AVE S
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-443-2837
Practice Address - Fax:218-512-0206
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2016-031A106H00000X
MN3577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist