Provider Demographics
NPI:1073521258
Name:PEARCE, CARL WESLEY (LPC, LMSW)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:WESLEY
Last Name:PEARCE
Suffix:
Gender:M
Credentials:LPC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 HAMBRICK RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-1746
Mailing Address - Country:US
Mailing Address - Phone:214-553-5420
Mailing Address - Fax:
Practice Address - Street 1:1333 CORPORATE DR STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2545
Practice Address - Country:US
Practice Address - Phone:972-753-7811
Practice Address - Fax:972-756-9269
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5622101YM0800X
TX0004460-039728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB0001613Medicare UPIN