Provider Demographics
NPI:1073101853
Name:PEARSON, KATHERYN NICOLE (MED,LPC-A)
Entity Type:Individual
Prefix:MRS
First Name:KATHERYN
Middle Name:NICOLE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MED,LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 PARADISE CV
Mailing Address - Street 2:
Mailing Address - City:SHADY SHORES
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5140
Mailing Address - Country:US
Mailing Address - Phone:281-415-7006
Mailing Address - Fax:
Practice Address - Street 1:1190 PARKER SQ
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7432
Practice Address - Country:US
Practice Address - Phone:972-899-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health