Provider Demographics
NPI:1295089308
Name:PEARSON, ANTHONY AM (MA, MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:AM
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MA, MED, LPC, NCC
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:AM
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:1768 FM 2673 UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-4768
Mailing Address - Country:US
Mailing Address - Phone:121-063-2035
Mailing Address - Fax:
Practice Address - Street 1:1768 FM 2673 UNIT 2
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133-4768
Practice Address - Country:US
Practice Address - Phone:210-632-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP1600X
TX201487106H00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist