Provider Demographics
NPI:1376662247
Name:PEARSON, THOMAS COLEMAN III (LLP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:COLEMAN
Last Name:PEARSON
Suffix:III
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8468 WOODCREST DR APT 5
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1319
Mailing Address - Country:US
Mailing Address - Phone:734-625-8857
Mailing Address - Fax:
Practice Address - Street 1:13101 ALLEN RD STE 400
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2216
Practice Address - Country:US
Practice Address - Phone:734-785-7705
Practice Address - Fax:734-785-7734
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010580103TB0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral