Provider Demographics
NPI:1417160987
Name:PEARSON, WILLIAM CLAY (MS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CLAY
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3579
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-3579
Mailing Address - Country:US
Mailing Address - Phone:505-862-9992
Mailing Address - Fax:505-862-9992
Practice Address - Street 1:211 W MESA AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6382
Practice Address - Country:US
Practice Address - Phone:505-862-9992
Practice Address - Fax:505-862-9992
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4206101YA0400X
NM0088461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58475532Medicaid
NM76591OtherC.E.U. PROVIDER
12705OtherS.A. P. QUALIFICATION
NM0042530087500OtherCFARS RATER NUMBER