Provider Demographics
NPI:1558616078
Name:KLEIN, PEARSON (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:PEARSON
Middle Name:
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 CRAPE MYRTLE LOOP #205
Mailing Address - Street 2:205
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4008
Mailing Address - Country:US
Mailing Address - Phone:956-454-8539
Mailing Address - Fax:866-587-2383
Practice Address - Street 1:1941 CRAPE MYRTLE LOOP APT 205
Practice Address - Street 2:205
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4008
Practice Address - Country:US
Practice Address - Phone:956-454-8539
Practice Address - Fax:512-330-9505
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-10524103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst