Provider Demographics
NPI:1922544691
Name:PEARSON, KIRA (LICSW)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 W LUDWIG DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68528-2711
Mailing Address - Country:US
Mailing Address - Phone:308-529-3770
Mailing Address - Fax:402-261-9274
Practice Address - Street 1:700 R ST # 321
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68501-0010
Practice Address - Country:US
Practice Address - Phone:308-529-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11104OtherDEPARTMENT OF HEATLH AND HUMAN SERVICES OF NEBRASKA