Provider Demographics
NPI:1558099010
Name:PEARL, CARTER ALEXANDER (PSYD)
Entity Type:Individual
Prefix:
First Name:CARTER
Middle Name:ALEXANDER
Last Name:PEARL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 E CAMELBACK RD STE 600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3493
Mailing Address - Country:US
Mailing Address - Phone:602-387-5313
Mailing Address - Fax:
Practice Address - Street 1:2198 E CAMELBACK RD STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4746
Practice Address - Country:US
Practice Address - Phone:602-387-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5661103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical