Provider Demographics
NPI:1659639318
Name:PEARSON, MEGHAN (MA TLLP, RAC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MA TLLP, RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1471
Mailing Address - Country:US
Mailing Address - Phone:269-948-8041
Mailing Address - Fax:269-948-9319
Practice Address - Street 1:607 N. BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1654
Practice Address - Country:US
Practice Address - Phone:269-948-8041
Practice Address - Fax:269-948-9319
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014989103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical