Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | TX | |
Y | 101YP2500X | Professional Counselor | 65741 | TX |
NPI | 1295089308 |
---|---|
Provider Name | Anthony A.m. Pearson |
First Address | New Braunfels, TX 78132-2011 |
Second Address | New Braunfels, TX 78130-7664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2012 |
Last Update Date | 29/10/2012 |