Provider Demographics
NPI:1255413456
Name:PIERSON, TARA L (LMSW, CAADC)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:L
Last Name:PIERSON
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 CENTURY LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4286
Mailing Address - Country:US
Mailing Address - Phone:616-396-5284
Mailing Address - Fax:
Practice Address - Street 1:483 CENTURY LN
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4286
Practice Address - Country:US
Practice Address - Phone:616-396-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010826641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical