Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6301016458 | MI |
N | 103TC0700X | Clinical Psychologist | 6301016458 | MI |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301016458 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY22977 | CA |
NPI | 1053504597 |
---|---|
Provider Name | Dr. Beth Lauren Pearson |
First Address | Ann Arbor, MI 48105-3205 |
Second Address | Ann Arbor, MI 48105-3205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2007 |
Last Update Date | 02/07/2019 |