Provider Demographics
NPI:1710219035
Name:PEARSON, BENJAMIN (LCSW)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 RAINBOW LANE
Mailing Address - Street 2:PO BOX 1000
Mailing Address - City:MIDWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84049
Mailing Address - Country:US
Mailing Address - Phone:435-654-1082
Mailing Address - Fax:435-654-1485
Practice Address - Street 1:375 RAINBOW LN
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:UT
Practice Address - Zip Code:84049-7001
Practice Address - Country:US
Practice Address - Phone:435-654-1082
Practice Address - Fax:435-654-1485
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT533760601-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical