Provider Demographics
NPI:1740603117
Name:PEARSON, ALEXIS (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 2ND AVE N STE 101
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6163
Mailing Address - Country:US
Mailing Address - Phone:208-370-8288
Mailing Address - Fax:
Practice Address - Street 1:155 2ND AVE N STE 101
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6163
Practice Address - Country:US
Practice Address - Phone:208-370-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IDLCSW-35048104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1558606962Medicaid