Provider Demographics
NPI:1467962811
Name:PEARSON, RODNEY (BS, MSPC, LPC, DMIN)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:BS, MSPC, LPC, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14324 W DESERT FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7518
Mailing Address - Country:US
Mailing Address - Phone:602-690-1643
Mailing Address - Fax:
Practice Address - Street 1:14324 W DESERT FLOWER DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7518
Practice Address - Country:US
Practice Address - Phone:602-690-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC5883T101YP2500X
AZLPC21139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21213Medicaid