Provider Demographics
NPI:1598169286
Name:PEARSON, MINDY
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 S PLEASANT GROVE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2878
Mailing Address - Country:US
Mailing Address - Phone:801-785-4622
Mailing Address - Fax:801-785-4623
Practice Address - Street 1:233 S PLEASANT GROVE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2878
Practice Address - Country:US
Practice Address - Phone:801-785-4622
Practice Address - Fax:801-785-4623
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10506019-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling