Provider Demographics
NPI:1295475416
Name:PEARSON BLOUNT, TERESA L (LMHC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:PEARSON BLOUNT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14607 TUSKEGEE AIRMEN WAY # 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5120
Mailing Address - Country:US
Mailing Address - Phone:347-506-8059
Mailing Address - Fax:
Practice Address - Street 1:14607 TUSKEGEE AIRMEN WAY # 2
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5120
Practice Address - Country:US
Practice Address - Phone:347-506-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health