Provider Demographics
NPI:1750639654
Name:PEARSON, BRYANT (MSW, CSW)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:PANGUITCH
Mailing Address - State:UT
Mailing Address - Zip Code:84759-0029
Mailing Address - Country:US
Mailing Address - Phone:801-589-0485
Mailing Address - Fax:
Practice Address - Street 1:400 EAST 200 NORTH
Practice Address - Street 2:
Practice Address - City:PANGUITCH
Practice Address - State:UT
Practice Address - Zip Code:84759
Practice Address - Country:US
Practice Address - Phone:435-676-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker