Provider Demographics
NPI:1154331593
Name:PEARCE, HELEN MARIE (ED D)
Entity Type:Individual
Prefix:
First Name:HELEN MARIE
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:DR
Other - First Name:HELEN MARIE
Other - Middle Name:
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD
Mailing Address - Street 1:7900 WOODWIND DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5259
Mailing Address - Country:US
Mailing Address - Phone:505-715-2459
Mailing Address - Fax:505-797-7628
Practice Address - Street 1:100 SUN AVE NE
Practice Address - Street 2:STE 650
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4670
Practice Address - Country:US
Practice Address - Phone:505-715-2459
Practice Address - Fax:505-797-7628
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMB2201OtherMEDICARE PTAN
NM00N6684Medicaid