Provider Demographics
NPI:1215221957
Name:PEHRSON, KENNETH TODD
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:TODD
Last Name:PEHRSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:K. TODD
Other - Middle Name:
Other - Last Name:PEHRSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:10228 ADOBE MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-6556
Mailing Address - Country:US
Mailing Address - Phone:702-823-9042
Mailing Address - Fax:
Practice Address - Street 1:10228 ADOBE MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-6556
Practice Address - Country:US
Practice Address - Phone:702-823-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-28
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health