Provider Demographics
NPI:1053504597
Name:PEARSON, BETH LAUREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:LAUREN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 PLYMOUTH RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3205
Mailing Address - Country:US
Mailing Address - Phone:734-997-5033
Mailing Address - Fax:844-855-5210
Practice Address - Street 1:3001 PLYMOUTH RD STE 105
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3205
Practice Address - Country:US
Practice Address - Phone:734-997-5033
Practice Address - Fax:844-855-5210
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-18
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016458103TC0700X, 103TC2200X
CAPSY22977103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical